Patient Non-Compliance issues and waste

Patient non-compliance: cost to taxpayers, the country, and to the health of the public:
I see many patients on a monthly basis that require Oral Surgery care yet are non-compliant with anti-hypertensive or diabetes medical management. Prior to treatment, as needed, they are directed back to a health care provider to reinstate the treatment. They follow this regimen almost universally because they realize that their health is severely compromised and that routine office oral surgery treatments, often pain-alleviating, will not be done until they are stabilized medically.


Treatment of stroke, peripheral vascular disease, blindness, loss of limbs and rehabilitation costs are in the billions of dollars. If a higher percentage of these patients followed more sensible lifestyles and were compliant with their medications, the cost to health care and utilization of the health care system would plummet.

One of the most effective way to bridge this gap in communication is via the County Health Department systems nationwide. Millions of dollars are wasted on ineffective education programs in libraries and hospital conference rooms instead of direct patient intervention. Dedicated staff in these departments could contact patients from lists provided by private and public clinics. These lists would be patients deemed by the provider as non-compliant with therapy whether due to economic, behavioral, or transportation limitations. Patients would be contacted on a daily or weekly basis until the provider felt that they were achieving better results, i.e. better HbA1C results for diabetic patients, average blood pressures, and various other clinical parameters. Funding for this could be state or federal and could be supplemented by the pharmaceutical industry. Phone reminders can be more effective if the staff is personable and caring. I was told by the NYS Department of Public Health there would be HIPAA concerns. This would not be the case if public health departments were deemed ‘limited health care providers’ and as such, would be privy to this data. Of course, having all preventative care always included as a no-extra-charge in a private policy, by law, will have to passed absolutely.

The pharmaceutical industry loses billions of dollars per year due to patient non-compliance with their medications. The pharmaceutical industry is aware of this http://www.in-pharmatechnologist.com/Industry-Drivers/Non-compliance-costs-drug-industry-dear

As on can see, they are more concerned with the economic loss vs benefit to patients health. This can be used as an incentive to provide some type of tax or voluntary contribution by pharma to a national county health department initiative as mentioned above.


Equally important is better communication of doctors with their patients and in-office education (link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1604357&dopt=Citation Physicians would benefit economically because their patients would visit when they were supposed to and the insurance would be billed for those visits. President-elect Obama is supportive of better electronic office communications. We need to work on this but not rush it through by 2011.

Results of the initiative could be reviewed in two-year increments and published by the Surgeon General to Congress.

For a very comprehensive review on the costs of patient non-compliance, see the link for the White Paper: http://www.idspackaging.com/Common/Paper/Paper_187/The%20Issue%20of%20Patient%20Non-Compliance-%20Response.htm


Sample tele-program and results: http://www.atmeda.org/news/2004_presentations/m1d2.dimmick.ppt#292,30,Conclusions

Most importantly, patients will benefit from a) less sick time b) increase in lifespan and quality of life 3) decreased burden on family and society to take care of preventable medical conditions, and as important 4) drastically lower premiums for health insurance. How many families in the middle class could sign up for a family policy if it were ½ of what the current averages are?

Two hugely overlooked problems are costs for providers tuition for medical and dental school. When medical, dental, nursing etc schools are free, then let’s talk about how to reduce health care costs more efficiently. Neurosurgeons go through 4 years of college, 4 years of medical school and 7 years of residency; do you think they can survive strictly Medicaid/Medicare-like pay?

Secondly, let’s say you get rid of all the health insurance agencies, health plans, etc.What happens to their jobs and what effect does this have on the economy? Have you heard any politician talk about how they would take care of that astronomic unemployment headache? I’ve heard they would ‘merge’ those workers. It’s not a slam dunk easy thing to deal with. It is laid out very simplistically (the merge phenomenon) but is very complicated.

The local health department teaches health classes at public forums….we know how many people attend those; you know, people who have 9-5 jobs line up for public health forums at 12 noon on the other side of town?. The reality is that we need better preventative programs. Education needs to start at the middle school and high school levels and more PSA's on healthy lifestyles on T.V. and cable.