To Incentivise a “Whole Health” Approach, We Need to Fix the “Wrong Pocket Problem”

The Importance of Whole Health

ISPOR 2024 emphasised a comprehensive approach to health, integrating physical, mental, and social well-being. This conference theme was prominently on display in the first plenary, where we heard a call to action from Denise Webb as she spoke about how her socioeconomic circumstances affected her and her family’s health and access to care.1 This “whole health” perspective is essential for tackling the root causes of issues that extend beyond traditional healthcare financing.

Societal Perspective in US Healthcare Economics

While the societal perspective is more commonly considered outside of the US, this does not negate the fact that American society is still significantly impacted by the health of the population. The inclusion of wider elements of value has been thoroughly discussed at ISPORs past, and this conference was no different. For instance, Dr. Charles Phelps discussed the need to use non-traditional, Generalized Risk-Adjusted Cost-Effectiveness (GRACE) methodology to assess the cost-effectiveness of treatments in chronic, progressive diseases that are intended to prevent disease progression.2 Despite such novel ways to evaluate cost-effectiveness and measure societal outcomes that consider more aspects of the value flower being brought to the table, there is a lack of discussion around incentives for US payers to actually consider such methods in decision making.

Understanding the “Wrong Pocket Problem”

Throughout the conference, the term “Wrong Pocket Problem” was raised across several sessions, referring to the problem that arises when the benefits of healthcare investments accrue to different stakeholders than those who bear the costs. Such misalignment often leads to underinvestment in preventive measures and therapies that provide broad societal benefits.

Shifting the Financial Burden

While considering whole health is great in concept, future research is needed into how we can move beyond the current model, where there is a clear divide between healthcare and social programmes and where the financial burden is placed primarily on healthcare payers and patients. Alternative funding models discussed include:

  • Involving sectors that benefit from a healthier population, such as employers and community organisations
  • Promoting policies that prioritise long-term health outcomes and cost savings
  • Developing public-private partnerships to support health initiatives with widespread benefits

Post-ISPOR 2024, it is clear that in order to practically consider whole health, we also need to address the “Wrong Pocket Problem,” which will require rethinking healthcare financing to improve health outcomes and distribute economic responsibilities more equitably. Embracing these strategies not only aligns with ethical imperatives but also with practical economic strategies to incentivise stakeholders to invest in a healthier society.

References

  1. Plenary Session 100. Advancing Whole Health: How do We Know When We’re Succeeding? ISPOR International Congress, Atlanta, Georgia, 2024.
  2. Breakout Session 228. Value Assessment and Reimbursement of Early Treatment for Prevention in Chronic Progressive Diseases: Are Traditional Approaches Up to the Task? ISPOR International Congress, Atlanta, Georgia, 2024.

If you would like any further information on the theme presented above, please do not hesitate to contact Sarah Neubert (LinkedIn). Sarah is an employee at Costello Medical. The views/opinions expressed are their own and do not necessarily reflect those of Costello Medical’s clients/affiliated partners.

Cookies Overview
Costello Medical

Our website uses cookies to distinguish you from other users. This helps us to provide you with a good experience when you browse our website and also allows us to improve our site. Cookies are files saved on your phone, tablet or computer generated when you visit a website and performs functions such as recognising you when you return to our website and helping our team to understand which sections of the website you find most interesting and useful.

You can select to accept or reject non-essential cookies using the toggle below. For full details of the cookies we use, please see our Cookies Policy and Privacy Notice.

Non-essential Cookies

We use these to collect information on how our users engage with our website so that we can improve the experience of the website for our users. For example, we collect information about which of our pages are most frequently visited, and by which types of users.