Cutting Medical Costs Can Be a Bargain
Much of the medical progress in the past half-century has involved expensive, high-tech diagnostic tests and therapies. But it would be a mistake to gainsay the value of inexpensive, low-tech innovations.
Consider the problem of falls, which are both a cause and effect of declining health in the elderly. They are the leading cause of injury-related visits to U.S. emergency rooms and of accidental deaths for Americans over 65. Preventing falls or reducing their impact would help millions of people and moderate health-care costs significantly.
For a 2017 study, a research group in New Zealand used an “older persons health ward” to compare standard vinyl flooring to low-impact flooring for rates of falling and injuries from falls. The latter type of floor is meant to cushion the impact of a fall, like the slightly spongy material used in many playgrounds.
The investigators recorded 278 falls by 178 people during 31 months. While the rate of falls was unchanged by the flooring, “fall-related injuries were significantly less frequent” when they occurred on low-impact flooring. There, only 22% of falls resulted in injury, compared with 34% on standard flooring. Many of those averted injuries were serious: Fractures occurred in 0.7% of falls for the low-impact flooring cohort, but in 2.3% of the control cohort’s falls on standard floors.
That’s more than a three-fold difference and a compelling rationale for adding low-impact flooring to housing for seniors. Other low-tech innovations have also done a great deal of good:
• Oral rehydration salt solutions. These cost-effective mixtures of salts, sugar and water (sometimes with zinc added), can treat symptoms of diarrheal diseases—which are often life-threatening in the developing world—and reduce the need for hospitalizations.
• Checklists in operating rooms and ICUs. A 2014 meta-analysis by Norwegian university researchers found that this low-cost innovation is an effective tool “for improving patient safety in various clinical settings by strengthening compliance with guidelines, improving human factors, reducing the incidence of adverse events, and decreasing mortality and morbidity.”
• Water fluoridation. Fluoride prevents the bacteria that cause cavities from entering the tooth, reducing dental decay. The Centers for Disease Control and Prevention estimate a quarter of Americans on public water systems are without access to fluoridated water. Introducing this proven measure more widely would decrease the need for many aggressive and costly dental procedures.
In the words of Lt. Gen. David Berger, the Marine Corps commandant, “Seek the affordable and plentiful at the expense of the exquisite and few.” High-tech miracles will continue to attract the headlines, but to control health-care costs we also need simpler, inexpensive innovations. Let’s put research dollars into finding them.
Dr. Miller, a physician and molecular biologist, is a senior fellow in health care at the Pacific Research Institute. He was the founding director of the Office of Biotechnology at the FDA. Dr. Sharma, a California dentist, owns Palo Alto Oral Health.