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Why don’t insurers focus more on preventive care?

why don't insurers focus more on preventive careMost of us do what we can to prevent things from happening to us in our everyday lives. We wash our hands. We brush our teeth. We wear sunblock. We wear seatbelts. All of these are preventive behaviors. But even with healthcare prices soaring out of control, we still see insurance companies ignoring the value of preventive behaviors.

They seem to prefer to pay to treat conditions and diseases once they’ve progressed to the point of surgical intervention. We need to turn to prevention as the preferred healthcare model. Just following the basic principles of prevention could lead us to a healthier and more cost-effective way of delivering healthcare in this country.

Let’s face it: We’re on track for some sort of healthcare overhaul, so let’s talk about some ideas and ways we can influence the industry toward this model of preventive medicine. Let’s talk about going from “sickcare”…to healthcare!

I never could quite understand how an insurance company would rather pay for a surgery or amputation costing tens of thousands of dollars than pay for a monthly or quarterly visit to the doctor (or nurse practitioner) that could have prevented that surgery in the first place.

We pay for oil changes in our cars to avoid having to shell out big money for a new engine don’t we? By offering to pay for routine check-ups that are the cornerstone of preventive therapy, insurance companies would be influencing their own patients’ actions and, in turn, rewarding healthy behavior.

Let’s look at the deadliest diseases that can affect our patients: diabetes, obesity and heart disease. For the most part, these are preventable. In fact, one of the cheapest and most common ways to prevent the onset of any of these diseases is simple exercise! Yet many of our patients seek miracle cures from miracle pills. The idea that there is a pill for everything is pervasive in our media. As a nurse, I find this trend to be a bit disturbing, and I work to dispel these myths and fight to share the truth about what really helps people.

I encourage my patients to exercise at least three times a week. It can save us all a lot in the long run, not only in terms of dollars and cents, but also in our overall health and sense of well-being. To this end, I believe that health club memberships should be covered by insurance. Furthermore, there’s a growing need for physical and occupational therapy, yet most of these visits are not covered by insurance. Why not? Those who need it would benefit greatly from the therapy, and many could avoid the rather expensive alternative of surgery altogether.

We need to encourage our patients to be more involved in their own decisions concerning their health, but they may not do this until insurance companies offer incentives for preventive behavior. The push toward prevention will empower our patients to take a more active approach and put them front and center where they belong.

We don’t just need insurance coverage for preventive care: we need to actually reward healthy behaviors in our society. In order to get us into this preventive way of thinking, we need new ideas concerning the delivery of healthcare. And the people on the front lines – nurses – are ready to give our input and our experience to help guide policy decisions. Just ask us. We’re not known for being shy.

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Jim DeMaria

James DeMaria, RN, BSN, is Vice President of Renal Care Registered Nursing Services, located in Nanuet, N.Y. Founded in 1991, Renal Care Registered Nursing Services provides acute kidney dialysis services to some of the northeast’s largest hospitals and caregiving facilities. While having had no formal business training, James has excelled as an entrepreneur, a role he must balance with his responsibility as a nurse, husband and father, and is always on call, explaining, “You never work harder than you do for yourself.” He is also cohost of “Nurse's Station,” a new audio podcast by and for nurses.
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