This blog is about a major driver of health care cost which has not received the attention I believe it should: Our own involvement in our health care and how COMPLIANT we are in doing the appropriate things to improve our health and, by extension, decrease the total cost of healthcare.
Compliance Along the Health Care Continuum
The last variable we will take up before we close this discussion on concerns about health care costs is one that you, the reader and patient, can control: compliance. In medicine, compliance describes the degree to which a patient correctly follows medical advice. “Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self-care, self-directed exercises, or therapy sessions.” It also applies to how well you take care of yourself. Both the patient and the health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance.
In a piece published in The New York Times on October. 31, 2000, a survey done by the Commonwealth Fund was analyzed, which found that, “scores of people who have money, health insurance and access to good medical centers are choosing not to go for checkups.”
I was volunteering at the local YMCA when I began chatting with a fellow volunteer. One thing led to another and the discussion finally got around to health care. Imagine my surprise when my fellow volunteer explained to me that I had neglected a very important group of health care consumers. She was correct. The health care consumer with good seats at the healthcare ballpark who are not encumbered by COST yet just do not get the healthcare they require. Here are some examples from the research I did subsequently to correct my lack of knowledge. Anyone you know?
“Mr. H.N., 33, a television producer in New York City, avoided doctors for years until his new girlfriend insisted that he get a checkup for sexually transmitted diseases. ’I guess I grew up with the mentality that your body heals itself and it’s a sign of weakness to go to a doctor,’ he said.
“H.N., says he no longer has a doctor he can turn to. About one in three men and one in five women have no regular doctor, a survey of 4,350 Americans projected. Money was a big concern, but beyond that, denial and embarrassment played a role, particularly for men.
And why are you or your fellow health care consumers with good seats at the ballpark not getting the healthcare they require? This major factor has yet to be addressed fully. In another blog we will discuss the uninsured and underinsured, those who do not have clear ACCESS to health care. As my fellow volunteer said there was another group of folks who do not interface with the medical profession: the non-compliant patient. Keep in mind, a lot of the forces motivating this segment of the American population may be similar to those that impact the underinsured and uninsured, but there is something different about this cohort.
“(P)ublic health experts agree that scores of people who have money, health insurance and access to good medical centers are choosing not to go for checkups.” 
Reasons For Non-Compliance:
- Aware of health-endangering vices
- Overly optimistic and convinced they will get better no matter what
- Embarrassed to discuss symptoms
In the 2013 Kaiser Women’s Health Survey, doctors discussed the multitude of reasons women don’t go to the doctor.  The focus was meant to be on factors other than cost, yet that was still a concern.
More than a quarter of women — 26 percent — delayed care in the past year because of cost, compared to 20 percent of men, according to a Kaiser Family Foundation survey of nearly 3,000 women. Uninsured women were far more likely to face cost barriers than either insured women or those on Medicaid.
If we get past the COST, low-income women couldn’t get time off work or weren’t able to find childcare. Finding the time was a common reason for women across all income levels. For lower income female wage earners, it often came down to not having sick days.
Why, then, do some men refuse to go to the doctor regularly?
“I don’t have a doctor.”
“I don’t have insurance”.
“There’s probably nothing wrong.”
“I don’t have time.”
“I don’t want to spend the money.”
“Doctors don’t DO anything.”
“I don’t want to hear what I might be told.”
“I’ve got probe-a-phobia.”
“I’d rather tough it out.”
“My significant other has been nagging me to get a checkup.”
Surveys show that nearly 60 percent of men won’t seek medical services for a serious health problem because of underlying fear and a desire to come across as macho.
And why is this subject so important? Compliance and Healthcare Cost go hand in hand.
The Healthcare Continuum is the life cycle of healthcare as we go from worried well to seeking care before we hit the slippery slope of the common chronic diseases, which may ultimately end at becoming seriously ill. Each of the stops along the curve is associated with healthcare cost. By not taking care of ourselves, we are not compliant with the medical treatment being provided. That is a contributing variable to the cost of American healthcare in transition.
The Health Care Continuum starts when we become concerned about staying healthy. I call this group the WORRIED WELL. Did you get your mammogram? Have you had your lipid levels (healthy/non-healthy cholesterol among others) checked? Do you know what your blood sugar is? Your blood pressure? Do you exercise? Watch your diet? All of the things we each know are good for us but even though simple on the surface, in actuality more difficult to do consistently. Most of us pay some sort of lip service to this as we are busy living our lives.
It’s important to know the projected impact of preventive services. I would recommend that you become familiar with the US Preventive Services Task Force (USPSTF) A and B Recommendations. These are the evidence-based things (A & B refer to good evidence) which you can do as part of the WORRIED WELL to improve your health care and minimize your downstream out of pocket healthcare costs. What might these things be? A wide array of pro-active activities from A through Z which include alcohol misuse: screening and counseling to diabetes screening to osteoporosis screening for women to visual acuity screening for children.
Then we actually become concerned about a real medical issue that happens to wonder into our lives, those darn tectonic plates again. A little elevated blood pressure. Perhaps the cholesterol is a little high. Some pain somewhere where it wasn’t before. We get sick with anything from the flu to pneumonia. In other words, we transform from the WORRIED WELL to actually SEEKING CARE. Those of us who are fortunate to remain in this position on the continuum will do so for longer periods of time. You and I have discussed ACCESS before. We will visit this issue again throughout our journey.
Eventually, for all of us, we will have to move on to the next phase of the continuum, especially if we have been less than forthright attending to the issues that brought us to medical care in the first place. This is called COMPLIANCE, but eventually we all enter that slippery slope on the curve called COMMON CHRONIC DISEASES. Care Management and improved compliance in the realm of chronic disease have a role to play on this slope of the continuum.
Here is where most of us live throughout our adult lives as we age. The shape of the slope will vary based on genetics and many other factors, but eventually we all enter this phase of the Health Care Continuum. Some of us will go on to become seriously ill with cancer or some other catastrophic medical issue. Even approaching the end of life will require more care. This is the very end of the continuum. We become SERIOUSLY ILL.
The AREA UNDER THE CURVE basically “signifies the magnitude of the quantity that is obtained by the product of the quantities signified by the x and the y axes. Why is that important? Because it is a way to measure how significant any particular intervention might be along the Health Care Continuum (or any curve for that matter). To be specific, if we are looking at healthcare cost (and we are), the AREA UNDER THE CURVE on our example above would represent the cost of health care for that particular segment. In this case, the representation of the cost of care for WORRIED WELL, SEEKING CARE, COMMON CHRONIC DISEASES, and SERIOUSLY ILL.
In actuality, the cost of COMMON CHRONIC DISEASES represents a large portion of the cost of care that results (in part) from how well we as patients are compliant with taking control of our health care. Therefore, if we are COMPLIANT as INFORMED CONSUMERS OF HEALTHCARE, we can impact not only the state of our health, but the cost of that care. Imagine if we were all compliant just a little bit more, we could inch our place on the HEALTH CARE CONTINUUM back toward the level of SEEKING CARE.
For every small incremental improvement, the impact on the cost of care as well as our health would be significant. A World Health Organization study estimates that only 50 percent of patients suffering from chronic diseases in developed countries follow treatment recommendations. The figures are even lower in respect to adherence rates for preventative therapies and can be as low as 28 percent in developed countries. “This may affect patient health and affect the wider society when it causes complications from chronic diseases, formation of resistant infections, or untreated psychiatric illness.” 
At the end of the day, how we choose to help ourselves along the Health Care Continuum is the final and most important piece of the transformational process of victim to informed consumer. However, as the Wall Street Journal asks in an article, “Can Consumers Be Smart Health-Care Shoppers? ”
I believe that we can.
 IBID www.nytimes.com/2000/10/31/health/major-medical-mystery-why-people-avoid-doctors.html
 IBID www.nytimes.com/2000/10/31/health/major-medical-mystery-why-people-avoid-doctors.html
 IBID kaiserfamilyfoundation.files.wordpress.com/2014/05/8590-women-and-health-care-in-the-early-years-of-the-affordable-care-act.pdf
 World Health Organization 2003. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization