In the dysfunctional world of today’s U.S. healthcare, there are reverse incentives to care for people with chronic illnesses. Why control blood sugar in patients with diabetes, lower blood pressure in those with hypertension, or control high lipids? Doctors and hospitals make our “margins” on the strokes, MIs, limb amputations, and renal dialysis and transplants that result from poor care. And health insurance companies have little interest in long-term care, knowing that people move from one insurer to another frequently. In fact, if you get sick, your insurer is highly motivated to move you on.
Someday our healthcare system, with costs rising hugely, will figure this out. When it does, the incentives will reverse. The low-cost interventions that can enhance care for people with chronic illnesses—self-management techniques, removal of barriers, etc.—will make good economic and human sense. For a psychiatrist this brings great hope—as a citizen and an administrator, for sure. But also because the low-cost interventions are largely behavioral. Getting people to live healthier lives, take care of themselves, promote safety, and care for chronic illnesses can be achieved with easy behavioral techniques—many deliverable electronically. Even more, reversing the current perverse incentives will open opportunities for treating comorbidities—e.g., patients with diabetes mellitus who are also depressed can be identified and treated for both, and the results will be enhanced care of physical and mental health—with improved quality of life and economic productivity. Someday—perhaps soon.
- Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry