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Over the past few weeks, national media, and yours truly, have been dealing with health-care reimbursement doughnut holes, black holes and the like, in an effort to show how changing certain key habits can lead to better health outcomes, for ever.

Last week, President Obama made it clear that he is favoring health-care reform, with the government playing a role in this, a big role indeed. Therefore, I’d like to take a brake from my blog’s “doughnut hole” sequence to address this topic, just this one time, and I will be back to …make the doughnuts next time.

First, lets put some stats upfront. It is a well known fact that Americans will spent 18% of GDP on health-care in 2009. Now is this bad? Some people argue we don’t spend enough. Look, each of us spends a bigger portion on our mortgage, our cars, etc., so the question is: what is the most important item to purchase in your life? It has to be health-care, the good that keeps us alive so we can spend on other items. I don’t believe the issue is the amount we spend, as much as it is what this spent buys us. It is my position that this spent has to be correlated with consumer behavior.

It has been argued that about 75% of health-care costs are derived by certain behavior. Another argument is that 75% of all costs can be attributed to less than half a dozen diseases, such as diabetes, obesity, cardiovascular and cancer. Furthermore, about 75% of these diseases are preventable, which is what I have been trying to show through out my “doughnut hole” discussion series. Thus, the magic rule for health-care cost control and improved health outcomes is 75/75/75. It gets implemented by starting to change behavior, which subsequently results in better outcomes and prevention, and this has to produce cost reductions.

The question is therefore how do we change behavior? Well, the model already exists in various forms and is currently utilized on the provider side. It goes without saying that it needs to be implemented on the consumer side. In its simplest form, each company will develop a personal diary for each employee, with specific incentives – and rewards, for things like exercising, weight reduction, cholesterol management and other metrics. The model scores an employee accordingly and based on these scores employees get rewards, such as premium reductions, etc.

Benefit design has to be modified to capture the so called “QALYs”, i.e., additional (or expected) Quality Adjusted Life Years a person gains by changing behavior. These pharmacoeconomic metrics are routinely calculated for various drug therapies by pharma companies; the missing link is the consumer reward. If I change my behavior and do away with obesity, I should be rewarded with the avoided cost for this disease.

The advantage of a behavioral change mandated by the 75/75/75 rule is based on the following: The 75/75/75 rule will produce better health outcomes and hence cost savings, for ever. The politically contrived – ever compromised by the two parties government plan, with its exorbitant, unsustainable costs and questionable outcomes is a quick fix; and quick fixes produce bad habits that demand more fixes. And yes you guested, too many fixes that don’t fix anything, need to be …fixed, again.

Did you find this article informative, thought provoking or interesting? If so, you may also enjoy visiting this blog: http://askDrNick-anything.blogspot.com

Dr. Nick Poulios, PhD – Scientist: areas of interest health outcomes research, quality of life, public policy, patient access, nutrition, fitness. Publications in peer-reviewed hep-C, MS, Alzheimers, Hemophilia. Entrepreneur: inventions, social media, personal development, wealth accumulation coach. http://askDrNick-anything.blogspot.com