“So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.”
– President Barack Obama, February 24, 2009

“Healthcare in America is sick…It costs too much, wastes too much, errs too much, and discriminates too much.”

These are the conclusions Leonard Berry reached after eight years of research that combines his dual areas of expertise, marketing and medicine. Berry’s is only one of the many voices in the U.S. calling for healthcare reform. As President Obama has committed to making such reform a priority of his administration in his first year in office, the question remains: what is to be done? It’s easy to point out the flaws in the system, but difficult to create affordable and effective solutions. From socialized medicine to mandatory insurance to digitization of medical records, where should the government begin, and what is the role of the individual and corporations in creating a healthier America?

“Healthcare in America is sick,” says Mays Distinguished Professor of Marketing Leonard Berry. “It costs too much, wastes too much, errs too much, and discriminates too much.”

Berry has a few ideas.

A Distinguished Professor of Marketing and professor of humanities in medicine at Texas A&M University, he has written extensively about healthcare after in-depth analysis of arguably the best healthcare available in the U.S.: the Mayo Clinic. He spent the 2001-2002 academic year as a scientist-in-residence at the clinic, examining what they do right and how practitioners everywhere can learn from Mayo to improve their service and their patients’ health. His partnership and studies with the clinic have continued for the past several years, culminating in a book titled Management Lessons from Mayo Clinic (McGraw Hill, 2008), co-authored with Kent Seltman, chair of marketing for the Mayo Clinic.

Berry’s findings have lead to numerous journal articles, including “Confronting America’s healthcare crisis,” in Business Horizons in 2008. In the article, he cites four general changes to the system that “are essential to meaningful improvement, and demonstrate the salient roles that individuals, the medical community, government, health insurers, and employers must play.” His recommendations are highly pertinent as the conversation about healthcare continues to evolve.

Heathcare reform starts with you

“Wellness cannot be delegated,” Berry says in the article. “Responsibility for health begins with each individual.” While this statement seems obvious, its truth of its impact is often overlooked. Berry cites a study that examines the impact of five factors on health: genetics; social circumstances (education, income, housing, crime, etc.); environmental conditions (such as toxic agents); behavioral choices (diet, exercise, chemical abuse, stress, etc.); and medical care. Guess which has the biggest impact on health?

“While recognizing the interconnectedness of the categories, the researchers concluded that the most deaths—approximately 40 percent—are caused by modifiable behavior patterns,” such as smoking and drinking less, maintaining a healthy weight, and eating right, says Berry.

A prime example of the importance of behavior modification is the American obesity epidemic. A 2004 study showed that between 1987 and 2001, 27 percent of the overall increase in healthcare costs went toward obesity-related illness, such as diabetes and heart disease.

“A 2004 study showed that between 1987 and 2001, 27 percent of the overall increase in healthcare costs went toward obesity-related illness, such as diabetes and heart disease.”

While the onus lies with the individual, Berry says that society has some responsibilities as well: to educate people about risky health behaviors and to provide affordable, healthy food as well as opportunities for physical activity (e.g., safe parks and playgrounds). “Individuals must take responsibility for their lifestyle choices, but society needs to assist; the health of people and the health of healthcare depend on it.”

A place to call home

Berry says an important feature of healthcare reform is the need for a “medical home” where a patient can establish an ongoing relationship with a primary care physician. The continuity of care that such a relationship provides is key to prevention, early detection, and management of disease, as well as coordination of care with other health services. Part of this benefit is that the more a patient sees the same doctor, the more likely it is the patient will adhere to that doctor’s recommendations, such as behavior modification (more exercise, improved diet, etc.).

Leonard Berry

Based on other’s research as well as his own ((Berry, L. L., Parish, J. T., Janakiraman, R., Ogburn-Russell, L., Couchman, G.R., Rayburn, W.L., et al. (2008). Patients’ commitment to their primary physician and why it matters. Annals of Family Medicine, 6(1), 6-13.)), Berry concludes that having a strong patient/doctor relationship can help the patient to formulate and stick to a personalized strategic health plan, more accurately decide when hospitalization or other medical treatment is needed, and effectively plan for end-of-life care.

End-of-life care is something that Berry is passionate about, as he believes it is too often full of needless expense and suffering, for patients and families. He cites several studies to back up his conclusions, commenting that about 27 percent of Medicare’s total budget goes to medical care for patients in the last year of life ((Appleby, J. (2006, October 19). Debate surrounds end-of-life expenses. USA Today, pp 1B-2B.)). Related to that number is the sobering statistic that 85 percent of Americans indicate they would rather die at home than in a hospital ((Kuehn, B.M. (2007). Hospitals embrace palliative care. Journal of the American Medical Association, 298 (11), 1263-1265.)). Having a medical home and a strong relationship with a physician means that patients are more likely to get the care they need at this critical time. “If America invested far more resources in palliative care and hospice care, it would spend far less on healthcare overall,” he says.

There are a few impediments to the patient/doctor relationship, including a medical payments system that rewards “episodes of care” rather than comprehensive, whole-patient care. Also, the number of primary care physicians in the U.S. is dwindling, as specialized medicine can be much more lucrative. These are issues that must be addressed as part of healthcare reform measures currently under scrutiny.

Insurance is a must

The need for adequate insurance coverage for all is something Berry and the Obama administration agree on. While details about universal coverage, mandatory policies, and single-payer options are still being hammered out, the President did sign the Children’s Health Insurance Reauthorization Act in February 2009. The act provides quality health care to 11 million kids in the U.S., 4 million of whom were previously uninsured. This was step in the right direction, but Berry says more action is crucial, as nearly 50 million U.S. citizens are without health insurance.

Having so many without insurance is inefficient, says Berry, as “three-fifths of uninsured people have no regular doctor or medical home, making them much less likely to receive preventative medical care or to properly manage chronic medical conditions” ((Ayanian, J.Z., Weissman, J.S., Schneider, E.C., Ginsburg, J.A., & Zaslavsky, A.M. (2000). Unmet health needs of uninsured adults in the United States. Journal of the American Medical Association, 284(16), 2061-2069.)). This leads to higher costs as this population has more dire healthcare needs, often met in expensive emergency rooms.

Though the President has taken much flack for the huge expense of the healthcare reforms he proposes, it cannot be overlooked that there is already a huge cost involved with caring for those without health care who can’t be denied some level of service at a hospital, whether they can pay for it or not. Berry also points out the economic drain caused by loss of capital and income by the ill and uninsured is extremely high each year.

Berry believes that the smartest approach to insurance reform is to build on the best features of the current system, rather than implement a new system that offers free universal coverage. “I believe America would be best served by a health insurance system in which individual households, employers, and government share responsibility for its funding,” he says. “The government must mandate that all citizens have sufficient health insurance and must enable those who cannot afford health insurance to obtain it.”

The new bottom line: healthy employees = healthy company

Health insurance for employees is one of the top expenses for most companies, however, Berry believes that employers will receive a better return on their investment by focusing on employee wellness. Berry cites a study that indicated absenteeism and “presenteeism” (when the employee is at work, but performing below capacity due to illness) cost U.S. companies more than $60 billion annually ((Stewart, W.F., Ricci, J.A., Chee, E., Morganstein, D., & Lipton, R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. Journal of the American Medical Association, 290(18), 2443-2454.)).

“The phrase healthy company typically refers to a company’s financial health. Managers need to broaden the meaning to include the health of employees,” says Berry, who sees corporate involvement as a major component in improving health care. Employers have a unique opportunity to influence employees’ behavior, the business smarts to make a program profitable, and the financial incentives to make it worthwhile, he says.

Berry offers suggestions for companies that want to save money by developing a culture of wellness within their organizations: on-site medical clinics for employees and their families; weight loss and smoking cessation support programs; exercise breaks during the workday; health screening fairs; healthier food options in the cafeteria; and reduction or elimination of employee co-pays on essential medication for chronic conditions, such as high cholesterol. “The most progressive managers believe that healthy employees are more likely to deliver healthy profits,” says Berry.

Berry acknowledges that healthcare reform is a complex issue that offers no easy, comprehensive solutions. However, he asserts that it is too important an issue to ignore any longer. “America does not need to spend more on health care. Rather, it needs to stop wasting so much of the money it does spend and spend differently.”

For more information

To learn more about the Obama administration’s goals for healthcare reform, visit www.whitehouse.gov/issues/health_care/.