Health care does not mean hospital: Prioritizing proactivity in medicine

A University of Minnesota medical student’s perspective on health care spending and what the future of medicine should look like.

Illustrator: Katie Heywood

What does health care mean to you? For some of us it means getting sick, going to the doctor, then becoming healthy again. For others, it means struggling to obtain insurance, keep a doctor’s appointment, and follow a care plan while addressing various social needs—child care, bills, housing, or relationships.

In the United States, we often prioritize reactive medicine, or worrying about being healthy only after becoming sick, instead of proactive medicine. For example, the U.S. spends $3.2 trillion on clinical care, with one-third of this money used for hospital-based treatments. The perceived value of spending this much money to become healthy generally includes having some of the best health outcomes in the world.

Unfortunately, this is not the case. The U.S. is ranked only 34th in the world in terms of overall health, as defined by life expectancy and infant mortality, among other factors. To contrast our reactive spending, roughly $6 billion of the federal budget is allotted to the Centers for Disease Control and Prevention (CDC). A portion of this funding eventually reaches state public health departments, whose overarching goals are to address potential health concerns before they reach the doctor’s office.

Clinical medicine, or what occurs within a health system’s walls, determines roughly 20 percent of an individual’s overall health. The U.S. spends over $3 trillion to impact 20 percent of the population’s determinants of health. Take some time to let that sink in.

Moreover, an individual’s physical environment, education, job status, and social support system—collectively known as “social determinants of health”—account for 50 percent of their total health and well-being. Consider the two mechanisms for purchasing health insurance in the U.S.: private insurance and public payers (Medicare/Medicaid). Both private and public insurance plans are designed to reimburse doctors and other medical professionals when patients come to see them with a medical issue. That means doctors are compensated significantly more when they treat Type II Diabetes than when trying to prevent the underlying risk factors of the disease itself.

In the United States, we often prioritize reactive medicine, or worrying about being healthy only after becoming sick, instead of proactive medicine.

Now what? The current insurance reimbursement structure propagates health care norms regardless of any evidence supporting their effectiveness. Health care policy makers freely propose programs to manage systemic shortcomings but are hesitant to enact systemic changes to avoid future consequences. Proactive health care takes time, energy, cultural competence, and an ability to swallow pride and put the needs of vulnerable patients first.

These issues are important for both you, a future professional, and me, a future doctor. You are, or will soon be, paying significant amounts of your paycheck to fund a system that does not work for those who need it the most. For me, I will see 20 patients each day, treat their acute medical needs, and probably not be able to address their upstream drivers of health and wellness. However, defining the problem is often much easier than identifying a solution. What would change if medical education stressed addressing social determinants of health? If health care social workers’ scope of practice extended to the community? If sub-specialist physicians’ salaries resembled those of family practice doctors? If our definition of health included social capital? Or, if current programs, such as community health workers, were a conventional aspect of medical intervention? I think we would see significant change in the health status of both individuals and communities.

So, the question is: Can you, a young adult, invoke positive change regarding the state of health care in our country? I say yes; as a future engineer, nutritionist, neighbor, or friend, you play a significant role in the well-being of those around you. Become an informed health care consumer who prioritizes healthy choices at home, school, and work. Recognize systems and policies that make it harder to be healthy, then advocate for change. Speak up, speak out, and challenge the status quo.