Education Essential to Improved Health Outcomes

WASHINGON, JULY 23, 2008--Conventional wisdom suggests that more health care services will lead to better overall health. That is not necessarily the case, said speakers at an AEI event on Wednesday, including Nobel laureate James Heckman of the University of Chicago.

Duke University's Barak Richman said the standard way of thinking rests on two assumptions: that more health insurance will increase health care consumption and that increased health care consumption will lead to better health. Richman cited his analysis of the Duke University employee population, which showed that wealthier individuals were more likely to utilize covered mental health services than low income individuals, thus demonstrating that expansion of public insurance coverage to include specialized benefits can lead to a regressive redistribution of wealth.

If more health insurance does not necessarily lead to better health, then what does? Heckman explained that individuals have the ability and motivation to make decisions to improve their health, and that early childhood intervention and education can positively influence those abilities and motivations. Robert Kaestner of the University of Chicago at Illinois showed that more education leads to better health behaviors, such as adherence to treatment plans provided by physicians and reduction in rates of cigarette use and alcohol abuse. "Getting people educated will improve public health," he said.

Both Dr. Michael McGinnis of the Institute on Medicine and Dr. Edward Hill, former president of the American Medical Association, pointed out that the main causes of mortality in the United States are related to the effects of physical inactivity, tobacco use, and excessive alcohol consumption. They also suggested that improvements in overall health could be achieved through better education, improved diet, more exercise, and superior individual decision making.

Education is also important in the clinical setting. People tend to choose less invasive and less costly interventions when fully educated about different treatment options and their associated risks and benefits, said Dr. David Wennberg of Dartmouth Medical School.

Tomas Philipson of the University of Chicago noted that obesity, which can increase the risks of heart disease, stroke, and diabetes and consequently results in substantial health expenditures, is caused by lifestyle behaviors outside of health care markets. He argued that in order for obesity to become such a significant problem, there must be some factors that offset its long-term health costs and risks. Curbing obesity will require understanding of these and the other causes of obesity, generation of better policy tools to incorporate external costs, and medical research to find ways to reduce individuals' propensity towards unhealthy diet and exercise decisions.

The event's speakers also questioned other traditional assumptions about health care. Louise Russell from Rutgers University showed that spending on medical prevention does not always lead to more cost effective care. When medical prevention efforts are targeted at high risk populations--using statins to reduce cardiovascular disease, for example--overall costs relative to benefits decrease. But broadening prevention efforts in other areas, such as increasing the frequency of screenings, leads to increased overall costs relative to benefits.

--WALTON DUMAS

For video, audio, and event information, visit www.aei.org/event1758/.  

For media inquiries, contact Véronique Rodman at 202.862.4870 or vrodman@aei.org.

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