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Show providers, including direct interviewing and even physical examination of patients by the consultant. Disease Prevention and Health Promotion, held at Westminster College, October 4. Discussion suggested a number of conclusions about the situation in Utah and how the state might proceed in disease prevention and health promotion. Among them were: 1. Not starting from scratch. The state has the difficult, but not impossible, task of setting priorities for disease prevention and health promotion. This comes from the limits on funds, time of providers, time and attention of the public, and other state resources. Fortunately, Utah does not need to begin from scratch in setting priorities; it can take advantage of an expanding national knowledge about relative effectiveness of various disease prevention and health promotion procedures. Two resources offering valuable points of departure, for Utah to adjust and to build upon as it finds appropriate, are: "Five-Hundred Life-Saving Interventions and Their Cost-Effectiveness." Tammy O. Tengs, Sc.D., et al., Harvard Center for Risk Analysis. The Guide to Clinical Preventive Services. prepared by the U.S. Preventive Services Task Force for the U.S. Department of Health and Human Services. 2. Make cost effectiveness a wav of thinking: On the one hand, cost effectiveness should be a primary concern in setting priorities. This recognizes the fact that financial resources are limited. On the other had, cost effectiveness should be used as a way of thinking, not as an absolute decision rule. Cost effectiveness analysis should not be counted upon to provide definite choices and to avoid the necessity of judgments, because it seldom can quantify all the factors which deserve consideration, such as community values concerned with care for the elderly and newborns. 3. The long term public interest sometimes is not met by the present market structure. Disease prevention and health promotion procedures which are cost effective for the society as a whole are not necessarily cost effective in the narrower and shorter-term perspective of employers and payers, and even of individual providers (e.g. smoking cessation), or patients (e.g. some immunizations). Some cost effective procedures will not be provided without adjustments or supplements to the market. 4. The state has a broad range of roles, which include: Regulation of insurance, providers, environment, safety, etc. Direct delivery of services through public health, Medicaid and other government health insurance, etc. Tax policy, not just to finance disease prevention and health promotion but to structure taxes and fees in ways which promote health (through lifestyles, safety, environments, etc.) Administration of state government agencies and programs themselves, to achieve safety, provide employee insurance, etc. State leadership in public health, education, business efforts, etc. These need to be combined and coordinated in experimental approaches which emphasize evaluation and flexibility to test and refine alternatives. 5. The role of insurance deserves further and careful consideration. The coverage of disease prevention procedures and the promotion of healthy lifestyles by health insurers are limited and spotty. Health insurance may, or may not, be a cost effective way of providing the services needed. In some instances government or payers may be justified in encouraging or requiring insurers to meet such needs; in other cases it may be appropriate to develop alternative methods (e.g. public education) to better assure disease prevention and health promotion. A combination of media campaigns, school-based educational programs, insurance benefit coverage, taxes and fees, and direct delivery of services through the public sector may all be needed to achieve success. Special Topics 130 |
