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Previous Volume 329:321-325 July 29, 1993 Number 5 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Health care costs in the United States exceed 14 percent of the gross domestic product, far more than in any other nation. Overall costs were $838 billion in 1992, or over $3,000 per person¹. Well over 30 million Americans are uninsured, partly because of rising premium costs^2,3. We propose an approach to part of this problem that has been neglected, one that focuses on systematically reducing the need and thus the demand for medical services. This approach requires expanding the definitions of "health promotion" and "preventive care," paying selective attention to strategies that have been found to result . . . [Full Text of this Article]

A Theoretical Solution -- Reducing the Need and Demand for Medical Services

The Potential for Reducing Demand

Much Disease Is Preventable

Risky Behavior Costs Money

Variability in Regional Costs Implies Slack in the System

Self-Management Can Result in Savings

Care for Terminal Illness Has Become Extraordinarily Expensive and Inhumane

Health Promotion at Work Has Successfully Reduced Costs

Redefining Health Promotion

Who Will Pay?

The Health Project

Problems and Caveats

Conclusions

Source Information

From Stanford University, Stanford, Calif. (J.F.F.); C. Everett Koop Institute, Hanover, N.H. (C.E.K.); William M. Mercer, New York (C.E.B.); Prudential Insurance Company, Newark, N.J. (P.P.C.); Washington Business Group on Health, Washington, D.(M.J.E.); Health Net, Woodland Hills, Calif. (R.F.G.); Sokolov Strategic Alliance, Los Angeles (J.J.S.); and the Tau Group, New York (D.W.). In addition to the study authors, the following persons are members of the Health Project Consortium: Charles B. Arnold, M.D., Metlife; Charles R. Buck, Jr., Sc.D., General Electric; Bruce Fried, Clinton Transition Team; Ron Hartwig, Hill and Knowlton; James Harrell, Dept. of Health and Human Services; Karen Ignagni, AFL-CIO; Dorothea R. Johnson, M.D., AT&T; Johannes Kuttner, the White House; James Marks, M.D., Centers for Disease Control and Prevention; Richard F. O'Brien, General Motors; Robert E. Patricelli, Value Health; Roger B. Porter, M.D., Office of Policy Development, the White House; Dallas L. Salisbury, Employee Benefit Research Institute; Jack Shelton, Ford Motor Company; John F. Troy, the Travelers Insurance Companies; and Reed Tuckson, M.D., Charles R. Drew University.

Address reprint requests to Dr. Fries at 1000 Welch Rd., Suite 203, Palo Alto, CA 94304.

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