DaytonDailyNews.com

The hospital sent Dr. David Westbrock's diabetes patient home with her medications, but didn't tell her what they were for or how to use them.

"You have to spend time with chronically ill patients and give them information," said Westbrock, the Washington Twp. endocrinologist who runs New Profile Weight Management Center. "A dietitian does that. A diabetes educator does that."

But few health plans pay for either them or physicians' time to help diabetics control their disease.

"We're sending the wrong financial signals," Emory University health economist Kenneth E. Thorpe said. As co-chairman of the Partnership to Fight Chronic Disease, Thorpe wants to change the fee structure that resists measures to keep diabetes from flaring up, but readily pays billions more a year for kidney dialysis or foot amputations when it does. The partnership is urging politicians to shift the industry's incentives toward preventing and controlling the chronic diseases that afflict 45 percent of Americans and lead to 70 percent of their deaths.

Each American pays about $5,000 a year in taxes, insurance premiums and unrelated medical bills to treat the most common chronic diseases — diabetes, stroke, high blood pressure, cancer and lung, heart and psychiatric diseases — more than twice what we pay for gasoline. The bulk of those expenses are avoidable through early detection, disease management and behavioral changes. But even though 75 percent of U.S. health care expenses go toward those seven diseases, only 3.3 percent of the industry's revenue goes toward trying to curb them.

As a result, it is neither financially nor logistically equipped to provide the "whole range of services," often nonmedical, that nearly all practitioners say a chronic patient needs. "These patients need a different model of treatment," Thorpe said.

The current model puts this country last among 19 industrialized nations in avoiding medically preventable deaths before age 75, the January-February "Health Affairs" journal reported. The top three countries' rate would eliminate 101,000 U.S. deaths a year.

"We get what we pay for," said Michael Millenson, president of Health Quality Advisors near Chicago. "And we don't pay for prevention. The incentives aren't there."

For example:

• Doctors get paid for office visits to diagnose and treat patients. The extra time with patients that reduces medical care not only brings scant revenue, but reduces those money-making visits. "What happens now," Thorpe said, "is if you don't take care of yourself, you'll show up at the doctor's office and then he'll get paid."

Low pay also diminishes family practitioners, keys to chronic disease, whose numbers in training residencies dropped by about one-half from 1997 to 2006. "In other countries, primary care is more respected and paid more equally to specialists," said Dr. Richard Schuster, director of Health Systems Management at Wright State University's School of Medicine.

• Hospitals have the same fee structure, rewarding surgery, procedures, drugs and diagnostic tests.

• Dietitians and other practitioners are best equipped to address the issues of nutrition, stress, exercise and tobacco behind many chronic conditions, but rarely reimbursed by insurance. "The No. 1 issue right now is nutrition," benefits consultant Scott McGohan of McGohan Brabender said. "Nobody's eating well, and nobody wants to pay for teaching how to eat right."

• Drugs and medical devices have some of the highest margins in health care, giving both motivation and resources to sponsor a growing share of medical research. The result: revelations of deceptive results, and insufficient studies of such disease-reducing vehicles as behavior changes and unpatentable nutrients.

• If an insurer offered comprehensive coverage for diabetes, for example, it would attract the higher bills of a sicker and less profitable population. Besides, health plans' turnover is so high, McGohan said, "they don't care about prevention for someone they won't have in two years."

So the latest trend in employers' health plans is lower premiums with higher deductibles, which "discourage chronically ill patients from getting the care they need" to avoid costly complications, Thorpe said, citing research last year by the National Bureau of Economic Research. Following financial inducements, he said, those patients wind up "with worse health and higher costs."

Contact this reporter at (937) 225-2129 or klamb@DaytonDailyNews.com.