Introduction
For years, the wellness community has been looking in the window of health care, hoping to be an integral part of health care delivery system, and obtaining reimbursement for their services. For many practitioners, it has been a constant struggle to justify their services. Some health reports state that since health promotion has done a poor job at creating proper outcomes, it has been hard for them to become part of the multifaceted health care program.
The introduction of HMO's in the 1980's has changed the face of health care, and health promotion. Since the primary objective of HMO's is to curtail health care spending, they are looking for innovative ways to save health care dollars. One way is through prevention and wellness programs.
Wellness and Cost Savings
Health promotion programs have saved money for companies for many years. In his 1981 text, Dr. Kenneth Cooper discusses the cost savings for corporations such as Tenneco, Ford Motor, etc. With the implementation of in-house health facilities, these companies have been able to track employee adherence, track physical changes, and measure cost-savings measures. In his 1988 book entitled: The Economic Benefits of Physical Activity, Dr. Roy Shephard looks at cost savings from an epidemiological perspective, tracking health savings over large populations over years.
Perhaps the most recent report on corporate savings is the highly publicized study from the Steelcase Corporation in Grand Rapids, MI. Over a 10 year program, the company saved over 50% in health care claims - a total of over 14 million dollars.
There is a mood in America today that saving costs may be taking precedence over quality of care. There are many in the medical world who are discontented over the tone of the HMO mentality, because they feel that their portion of medical practice may be in jeopardy over the next few years. The solution may not be wellness, per se, because the portion of the health care pie allocated to wellness (however small), may be taking reimbursement dollars from other elements of health care. If you prevent a serious medical condition from manifesting in the first place (primary prevention), that patient will never seek medical attention, because it has never happened (re-allocation of funds). It is easy to see why even health care professionals are leery of the barrage of wellness programs that are springing up over the country in clinics, health clubs, and hospitals. It may mean that these patients may not see them for health issues, because they have participated in alternative programs. None the less - there is a relationship between smart medical professionals (such as Dean Ornish), and health promotion specialists who wish to combine the elements of education, health, and classic medical practices.
Where Medicine Fits In
The world of health care has two elements. One is competition - which is part of the American way of business. Millions spent for drug research, marketing new devises, techniques, and medications. Hospital mergers, additions, and closings. Employee turnover and the new work force. The second element is monopolistic. Licensure laws, legislation, and state statues have guaranteed some health care professionals an almost monopolistic reign over their services. It is impossible to obtain reimbursement for certain types of "alternative programs", while more expensive medical services are paid for (many times at taxpayer expense) through insurance payments.