At the World Healthcare Congress this year, Dr. John Kitzhaber stated that your behavior, and the social context in which you live are the two big, controllable factors that influence your health (see chart).
The healthcare you receive is a small factor on health: only a 10% influence on your health status. Kitzhaber is an MD who is in his third term as governor of Oregon (and hence CEO of a very large healthcare payer).
If you start with the question, “How can healthcare resources be used most effectively to give people longer, higher quality life?” then it’s obvious that investment in programs that can change behavior, identify chronic disease early, and help people cope better with their social environment has much more leverage: this is “proactive” medicine.
20% of healthcare resources spent here targets 55% of the health status pie, while the 80% of resources spent on reactive medicine targets 10% of the health status pie: that’s a 20x difference in the ratio of healthcare cost to potential effectiveness.
Proactive medicine is mainly primary care, behavioral health, public health, and wellness programs. It’s the part of medicine that has been generally defunded and reduced in status in the last generation, as resources and culture focused on the high-tech cure and as the incentive system rewarded higher volumes of higher value procedures.
Proactive medicine can be difficult because it requires really getting to know people and working with them over time to help them change their lives. As you can see, the payoff is worth it.