Redefining Health

Two weeks ago a reader asked me to comment on Gilbert Welch's NY Times essay arguing for a new definition of "health." Dr. Welch - a former instructor of mine at The Dartmouth Institute for Health Policy and Clinical Practice - claims that the current definition drives costs by encouraging experts to deliver health care services that provide limited benefits. Although I agree that patients should take a more active role in their health care, I also think that the burden for regulating costs should not fall on patients alone.

According to Dr. Welch, current thinking equates health with the absence of abnormality. He says this is a problem because "all of us harbor abnormalities." Since everyone is abnormal everyone is also unhealthy and needs care services. This creates unlimited demand for health care services despite limited supply and thereby drives costs.

To restrain costs Welch proposes that patients redefine health. He says, "You have to take back responsibility for deciding what health really means, not surrender that decision to 'experts' with strong financial incentives." He encourages non-health care providers to assume responsibility for curbing costs by developing individual definitions of ideal health.

Although I support Dr. Welch's call for greater layperson involvement in health care decisions, others must also play a role in reducing health care costs. In particular, policy makers should work to limit the financial incentives that drive the "experts" to seek and treat every abnormality. Health care providers must also take a more active role in restraining costs. Doctors and nurses should understand the limits of health care resources and avoid administering services that provide few benefits. If redefining "health" helps limit costs patients, policymakers, and providers alike should collaborate to develop a new meaning.

Photo credit: Shannon Stapleton/Reuters via NY Times