Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost

Abstract

We used a dynamic simulation model of the US health system to test three proposed strategies to reduce deaths and improve the costeffectiveness of interventions: expanding health insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. We found that each alone could save lives and provide good economic value, but they are likely to be more effective in combination. Although coverage and care save lives quickly, they tend to increase costs. The impact of protection grows more gradually, but it is a critical ingredient over time for lowering both the number of deaths and reducing costs. Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent.A mericans are engaged in a longstanding quest to fundamentally improve the US health system. The Affordable Care Act of 2010 instituted a range of provisions to expand insurance coverage; improve health care delivery; and also protect the population's wellbeing by enabling healthier conditions in homes, workplaces, schools, neighborhoods, and other locations.As this law is implemented and other steps are taken to create a more healthful and affordable system, it is useful to question how these three basic intervention strategies-coverage, care, and protection-affect the nation's health and economic outcomes, individually or together. How much of an impact can each component have? Are their effects complementary or synergistic? How fast can they yield results-and how long might those effects last? Answering these questions requires a macroscopic analysis of the health system as a whole, with attention to the dynamic processes that connect its distinct parts and produce changes over time.We estimated the relative and combined health and economic impacts from expanding health insurance (referred to in the rest of this paper as coverage); delivering better preventive and chronic care (referred to as care), and enabling healthier behavior and safer environments (referred to as protection). Our study did not analyze the probable effects of the implementation of the Affordable Care Act. Instead, we began all simulation experiments in the early 2000s (based on data availability) and asked what might have happened had the United States taken decisive action in these three areas about a decade ago.In particular, we considered each strategy separately and together by charting their likely consequences over a twenty-five-year period. A review of these alternative trajectories may help Study Data And MethodsThis analysis builds on a previously published mathematical model of the US health system developed by the Cen...

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