If an apple a day keeps the doctor away, so too does exercising
regularly, quitting smoking, and obtaining a flu shot. The goal is
to eliminate the preventable diseases that ravage our bodies and
strain our health care finances. "At least 50 percent of health
care expenditures are lifestyle-related," says Texas Commissioner
of State Health Services Eduardo Sanchez, MD, MPH, "and therefore,
potentially preventable." It is incumbent on individual Texans and
their families, physicians and other health care professionals,
employers, health plans, and the government to focus on wellness
and prevention. We cannot afford, physically or fiscally, to do
Texans must take more individual responsibility for the
financing of their employer-provided or individually owned health
Patients who have a stake in the cost of their health care
treatment decisions are more likely to make decisions that are
cost-effective. TMA believes employers and health plans should
aggressively pursue innovations in health insurance benefit design
to encourage affordability, accessibility, disease prevention,
health promotion, and individual enrollee participation in health
Consumer-directed health care plans offer a promising option for
improving efficiency and increasing personal responsibility by
excluding the insurance company from financing a large portion of
routine primary care services. Under these plans, businesses
establish high-deductible insurance plans for their employees,
coupled with accounts that employees can use to cover their
family's routine medical expenses with pre-tax dollars.
This approach improves efficiency if these plans bypass the
usual process of submitting formal medical claims to insurance
companies and waiting for lengthy review and payment. It
strengthens the practices of primary care physicians who are
particularly overburdened by the demands of health plans to have
every small service pass through their scrutiny. To the employer,
the employee, and the physician, the value of consumer-directed
health plans lies in their simplicity.
To be successful, high-deductible health plans must not just
shift more costs to workers who may not be able to afford the
higher costs and may thus decline coverage. These accounts should
be seeded with initial funds and allowed to grow with tax-free
employee savings that roll over from year to year. Benefits should
promote employees' use of preventive health care services, such as
cancer screenings, immunizations, and prenatal care. Administrative
overhead must be minimized through the use of debit cards or other
methods that limit transaction costs for all parties.
To promote individual responsibility, TMA recommends:
Enacting tax breaks or other incentives for employers who
offer appropriately structured, consumer-directed health plans
to their workers.
Directing the Employees Retirement System of Texas to devise
innovative and affordable ways to offer appropriately
structured, consumer-directed health plans to state
Encouraging employers and health plans to engage in
educational efforts to make employees better-informed health
The obesity epidemic threatens Texas' physical and fiscal health.
Demand for treatment for obesity-related conditions is beginning to
overburden the health care system. Obesity is responsible for 27
percent of the growth in health care spending. Treating obese
patients costs 37 percent more than treating normal-weight
Research shows that increased fitness levels correlate
positively with student academic performance and test scores. A
child who is overweight at age 12 has a 75-percent chance of being
overweight as an adult. The 2001 Texas Legislature passed Senate
Bill 19 (expanded by Senate Bill 1357 in 2003), requiring daily
physical activity for all children in kindergarten through grade 6.
There still are many questions about whether schools are
implementing this law, and if so, how.
Vending machines provide additional revenue for schools.
However, most serve primarily low-nutritional value food and drinks
that only exacerbate the obesity problems among schoolchildren.
To combat this epidemic, TMA recommends:
Providing state employees or their family members incentives
- for example, reduced health insurance cost-sharing - for
making healthy lifestyle choices, such as maintaining a healthy
weight, quitting smoking, or keeping their children immunized.
The state should test effectiveness of similar incentives for
Medicaid and CHIP.
Reinstating the smoking cessation benefit for CHIP and
testing the effectiveness of including weight loss and smoking
cessation programs as covered benefits under Medicaid and
Assuring full compliance with Senate Bills 19 and 1357,
including an appropriate means of reporting daily physical
activity and expanding daily physical activity requirements to
all grade levels.
Improving school nutrition by (1) codifying the public
school nutrition policy developed by the Texas Department of
Agriculture, and (2) evaluating compliance and accountability
concerning the new requirements to replace food and drinks of
low nutritional value with those of documented value.
Immunization is one of the safest and most cost-effective ways of
protecting young children. However, a close look at the poor
reimbursement levels for providing and administering vaccines
explains one of the barriers to vaccine administration in the
physician's office. As these costs are 50 to 100 percent greater
than the doctor's reimbursement for giving the shot, many
physicians find it cost-prohibitive to provide immunizations to
their patients. This obliges more-motivated parents to take their
children to publicly funded clinics. Others skip the vaccines
altogether until public school requirements force the issue. With
the advent of Texas' conscientious objector law, even that hammer
has lost some of its impact.
The destruction of medical records and mass migration of Gulf
Coast residents that accompanied Hurricane Katrina brought to light
a new problem related to immunizations. States and parents are
responsible for maintaining vaccination records. When the parents'
paper records are lost and the state's computers are down or
inaccessible, physicians in shelters and clinics or in the
hurricane victims' newly adopted hometowns don't know the
children's vaccination status. Adults' immunization records, even
for those who have never moved or weathered a hurricane, are even
more difficult to find. When seeing a patient with an unknown
immunization history, physicians will err on the side of caution
and administer the shots they think the patient needs. This wastes
precious health care dollars, time, and resources. A national
immunization registry, especially for children, would integrate
data from the 50 state-level registries.
To promote immunizations, TMA recommends:
Supporting the Texas Department of State Health Services'
request for increased appropriations to enhance vaccine
services through the Texas Vaccines for Children Program.
Opposing any expansion of the conscientious objector
Increasing funding for education and practitioner vaccine
administration reimbursement fees.
Strengthening Texas' ImmTrac immunization registry.
Establishing a national immunization registry based on
Mental illnesses account for more than one in every 10 days lost to
illness. That's second only to heart disease, and closing fast.
Untreated mental illness costs the United States $300 billion each
Wall Street Journal
has estimated that depression alone costs American companies $70
billion annually in absenteeism, lost productivity, and direct
medical costs. Untreated mental illnesses also can cause what's
been termed "presenteeism," when employees show up but are not able
to work to the best of their abilities due to their psychiatric
symptoms. A recent Rand Corporation study showed that an annual
investment of $500 per employee in mental health more than pays for
itself in increased worker productivity.
Suicide is the eighth leading cause of death in the United
States. About 20 percent of the 2 million people in American
prisons suffer from severe mental illnesses. Mental illness
contributes to dropout rates, special education placements, and
grade retention in our schools. It is associated with teenage
pregnancy, drug and alcohol abuse, and unemployment.
These diseases touch a fifth of all Americans and are the
second-leading cause of disability in the United States. However,
we spend only 7 percent of our health care dollars to treat them.
There's less health care coverage for behavioral issues, higher
costs to consumers, and lower reimbursement rates for providers. In
addition, there is a dearth of mental health professionals to deal
with the magnitude of the problem, particularly for children and
persons living in rural areas.
To strengthen our mental health system, TMA recommends:
Encouraging employers to include mental health components in
their workplace wellness programs and strong mental illness
coverage in their health insurance benefit plans.
- Requiring mental health equitable treatment (parity) of
health insurance coverage for psychiatric brain disease and
malfunction (mental illness including substance abuse/chemical
dependency) equal to that for other medical conditions.
Increasing funding for mental health research and graduate
medical education programs in psychiatry, child psychiatry, and
Funding core mental health services and support to those
persons with severe and persistent mental illness who are most
in need, indigent, and have no third-party coverage.
Goal 3: Wise and Effective Use
of Health Care Information Technology
Karel RB. Another Study Confirms Parity Is Affordable.
Psychiatric News; 2005. Accessed November 2005 at
Kennedy PJ. Mental Health Policy in the 21st Century.
Presentation at The University of Texas Southwestern Medical
Center, Department of Psychiatry; Jan. 28, 2002.