Do patients and the healthcare business model contribute to climate change? Although clinical waste and pollution take many forms, the biggest drivers of these emissions appear to be hospitals and drug companies.
Much has been written about the possible relationship between climate change and its effects on health. In contrast, the possible relationship between healthcare consumers, the healthcare business model and climate change has barely been discussed.
Do healthcare consumers contribute to climate change?
Before we lay fault with all the other stakeholders in the healthcare industry for playing a part in climate change, let us look instead at ourselves. We need to see what we can do individually to lessen healthcare usage and its impact on the environment. Regretfully, diabetes, hypertension and cardiovascular-related events are all on the rise and chronic illnesses like these play a major role in increased medical waste. However, there is a positive side – many of these diseases can be reversed by making lifestyle changes.
Diabetes, hypertension and cardiovascular-related events are all linked directly to our eating habits and the rising incidence of obesity. Therefore, it would seem reasonable that the very first order of business for reducing healthcare’s impact on the environment is for us to get serious about our own wellbeing and get involved in preventive health. A behavioral modification program, reinforcing healthy dietary and lifestyle choices, may lessen our healthcare consumption and help to reduce the healthcare industry’s impact on the environment.
Is the current healthcare business model partly responsible for affecting climate change?
Certain healthcare sectors like cosmetics, infertility and weight-loss are consumer-driven. Patients pay for these services, not insurance plans. Therefore, there exists cost-transparency, cost-control and performance-based competition because access is consumer-directed according to demand. In contrast, most other healthcare consumption is NOT consumer-driven but largely fueled by a fee-for-service business model.
This payment option is used by government-sponsored health programs, such as Medicare and Medicaid, nationalized health systems, single-payer systems, and plans run by the health insurance industry. When this fee-for-service business model is used for routine medical needs, it does not encourage or reward consumer behavior towards preventive care. In contrast, the more consumers seek testing and treatment (since insurance plans are paying) the more providers will recommend costly testing and treatment. In fact, for the greater healthcare industry, there are simply no mechanisms in place to keep healthcare expenditures competitive, in-check and consumer-driven. Instead, a payment model for healthcare that rewards all caregivers for production only encourages more production and no improvement in our health. Furthermore, this fee-for-service model that rewards production also commonly exposes the public to unnecessary testing and treatment, medical errors, more costs and results in more health-related waste.
How can patients and the healthcare industry work to lessen their impact on the environment?
To put the brakes on the out-of-control costs, waste and pollution in healthcare the public needs to get serious about preventive health. In addition, the health insurance industry needs to be steered towards a consumer-driven business model. This template has already been proven to be effective in stabilizing usage and costs (and therefore waste) in several other healthcare sectors. Consequently, there should be no reason why cost-transparency and the direct pay model shouldn’t lead to cost-savings and less healthcare waste when applied to routine non-emergency care, laboratory studies, imaging and rehabilitation.
With a direct-pay model in place, employers and the government can realign health plans towards more affordable and likely, a more environmentally-friendly universal catastrophic coverage program.
Christensen, J. Grossman, M.D., J. Hwang, M.D., “The Innovator’s Prescription”.