The well publicized controversy over extending Medicaid in my home state of Utah has diverted the public’s attention from another health care issue being discussed by the legislature: free health care for the homeless, no doubt a worthy cause. Both issues have an unfortunate common denominator: providing pharmaceutical health care that has been shown to cover only 10% of the factors that affect a person’s health:
“Bridging the divide between health and health care,” JAMA 2013;309:1121
“Health Care delivery accounts for only 10% of preventable deaths, with the remainder attributable to personal behaviors, social and environmental determinants, and genetic predispositions. As currently constituted the Health care delivery system has little direct control over these other factors. However, consensus is developing that truly controlling health care costs and improving the overall health of Americans will require a much closer partnership, permeable boundaries, and increased interdependence among the health care delivery system, the public sector, and the community development and social service sectors.”
“To create a culture of health will require creating a market for health, moving away from the current market for treating disease.”
“Accountable health communities,” JAMA 2014;312:2093
“There is also an increase recognition that resources tilt disproportionally toward health care, that much of that is wasted and that redirecting even a portion of health care savings to support proven interventions addressing the upstream determinants of health could achieve substantial returns.”
The annual cost of one drug is about $11,000. Say each homeless person is prescribed three drugs a year. Do the math. Do you think that perhaps getting them a decent shelter and a couple of hot meals a day may be cheaper and more effective in treating and preventing disease?