DEMYSTIFYING HEALTHCARE: MEDICAL CARE, SOCIAL DETERMINANTS & HEALTH OUTCOME
By Atif Zafar, MD
Healthcare is not equivalent to medical care which is not the same as sick care.
Here is my copywrite formulae:
1) Medical care = preventive care + sick[interventional] care
2) Healthcare = medical care + public health & policy. Now healthcare is measured in its performance by experiences, outcomes, and cost. This measured approach to healthcare is what many of us call the value based care.
To have a true value based care model, understanding health outcome is critical.
(Health costs and experiences can be ignored for simplicity, for today's discussion. For those who complaint about costs, let me tell you alcohol industry is close to 2 trillion dollars annually. Tobacco and smoking 1 to 2 trillions.)
So going back to what matters:
3) Health outcome = healthcare + socioeconomics + genetics + environment + behaviors.
Medical care is 20% of what matters to an individual's health outcome.
Add smoking, alcohol, diet and exercise and combined they have 50% impact on healthy living of people.
Remind you, lack of access to equitable gyms, easy access to junk food, legalizing alcohol abuse and tobacco use are not what "healthcare" system has control over.
Educating patients is not as strong of a tool alone. We learnt that during COVID vaccination drives.
So all of us doctors, nurses, techs, HCAs, hospitals, clinics, pharmacies, literally the so called healthcare system, in reality is a very small part of what matters for individuals and societies health related well being.
The problem is those who drive, lead, innovate, and execute in the healthcare system, don't or can't influence (enough) the social determinants that impact longevity, healthy living, and independence duration.
If they did alcohol and tobacco would have been banned.
The trillion dollar healthcare system is actually just a medical care system having only 20% impact on longevity, independent healthy living of an individual.
Social, behavioral, physical, environmental factors account for majority of a population’s health outcomes.
The future of personalized, equity based "healthcare" can not be functionally possible by focusing on medical care alone, like the current traditional healthcare system tries to do. My dream of seeing a personalized equitable, patient centric healthcare model will have medical care directly connected, communicating daily with social determinants, economics, genetic and environmental factors. Technology will drive that coordinated care. The winner will be the patients.