Remarks at Washington Business Group on Health Annual Conference

Wriston, Walter B.


Thank you, Bill....

First, I want to thank all of you, and your business colleagues, for the support you've given the Business Roundtable Health Initiatives. Each effort reinforces the other, and together we are beginning to make some progress.

Health care in its various forms has a long and fascinating history but until recently most businesses have not focused on its impact on their business. This is understandable because until the 20th century, the actual impact of medical science upon human life was pathetically slight--indeed it had little effect on the death rate.

Through much of antiquity, medicine was regarded as a semi-religious profession, and disease considered a punishment or an evil presence to be driven away.

The most important health care development of the ancient world came in the Fifth Century BC, when Hippocrates of Cos devised his famous case study method of taking and keeping notes on patients. Until that event, there was little organized knowledge. This simple change of emphasis--from the disease to the patient--has formed the basis of all modern care, up to and including computerized health profiles.

But the world's great medical improvements did not come until the industrial period. The development of anaesthesia, for example, made modern surgery possible. But it wasn't an easy passage. In 1842, an American, William Clark, pioneered the surgical use of ether. In 1847, Sir William Simpson tried using chloroform. He and two assistants inhaled it and fell simultaneously under the operating table.

Despite such minor setbacks, medical innovations have continued with astonishing rapidity. In our lifetime, high technology and computers are producing as great a change in the way illness is diagnosed and treated as did Leeuwenhoeck's microscope or Roentgen's X-ray. Business managers are now becoming concerned with the impact of new technology on health care and the escalating costs to their companies.

I know of one company today that can provide your employees with complete computer generated health profiles. These are based on employee answers to a medical questionnaire. Furthermore, after scanning the answers, the computer can quite accurately calculate any employee's life expectancy and is programmed to issue that employee a report indicating ways he or she can extend it. While there's nothing remarkable about this, I'm told that when answers to the questionnaire warrant, the computer has the option of addressing its report "To the Estate of."

We've made great strides in conquering some of man's age-old complaints, but technology itself can unwittingly produce new health hazards, from automobile accidents to a new syndrome called Walkman's Disease. Its sufferers fall victim to all sorts of freak accidents, like falling under buses, because they simply can't hear warning shouts and signals.

In the same vein, historian Hugh Thomas reminds us that the Dutch Wars of the Seventeenth Century were won by England, but that many Englishmen were soon conquered by the new Dutch invention of distilling juniper berries into gin. Distilling technology changed the drinking habits of the entire modern world, and made possible alcoholism on a massive scale. The problem persists. Just last week, a report to Governor Carey of New York confirmed the continuing cost of alcoholism. Health care for an alcoholic, or problem drinker, now averages $2,000 a year more than for a non-alcoholic.

Obviously many modern health problems are preventable. Alcohol abuse, smoking, drugs and improper diet, for example, contribute to high percentage of illness--for which we all pay. Smoking has gotten an increasingly bad press. Last February, the Surgeon General went so far as to label smoking as the "chief preventable cause of death in our society."

One reliable study estimated that the direct cost in medical expenditures due to alcohol and smoking was $20.2 billion or about $1 out of every $5 spent on health in the U.S. The economic cost, which included lost earnings, was even greater: $59.6 billion, or about one quarter of the total economic cost of illness in the U.S.

It's no wonder then, that corporations are increasing their emphasis on programs of preventive care and health maintenance. The price of illness for a corporation involves not only the human suffering and the medical bills of the employee, but also the loss of a trained, productive individual and the expense of his, or her, replacement.

Once we help employees to take more responsibility for their own health, through the provision of more sophisticated employee health programs--programs that deliver more information--we can expect people to manage their own health more aggressively.

I've heard arguments that such programs do nothing but postpone inevitable illness and its cost. That may be true in some cases, but in others, such as cardio-vascular disease--where the first symptom is often death--more information can save lives.

If plaque is building up in an employee's carotid artery or there's some weakness in the wall of his abdominal aorta, early diagnosis can allow him to change his lifestyle, to make informed judgments, or even consent to elective surgery. All are certainly preferable to a sudden stroke or an aneurysm.

Giving employees regular information about their physical condition will also motivate many to maintain their basic health over the years of their employment--and beyond--and remain at the peak of productivity.

The future of employee health programs may be greatly assisted by technological advances that can deliver improved, non-invasive diagnosis or monitoring. The hospital of the future may even be worn on your wrist.

Today, CAT scans and ultrasound imaging can dramatically increase diagnostic capability, without the need for risky exploratory surgery. These techniques can-only be viewed as a revolution in health care, but they carry big capital costs. Some of the costs are substitutions, for other more dangerous procedures, but over time it is clear that we as managers, must determine how our benefits plans can be designed to help employees use this new technology wisely.

As business men and women, we must also help health care providers decide on the number of such new devices needed by a community, so that efficient use is assured. And we can also work with those providers to develop good utilization review programs.

Improved diagnostic capability is, of course, going to require planning and cooperation among companies, physicians and community hospitals. If doctors and hospital administrators prepare properly, then we should see the development of a leaner network of facilities. Instead of more brick and mortar hospitals, funds can be allocated to satellite outpatient surgical centers, mobil diagnostic imaging and laboratory test facilities, interactive computer systems for patient education and flexible-use patient accommodations.

Sophisticated information systems will also affect the education and supply of physicians.

Just two weeks ago, the Dean of Harvard Medical School proposed some radical curriculum changes that include training all young doctors to use computers so they can keep up with the explosion in biomedical knowledge, and putting a greater emphasis on compassion and understanding of patients. The two must go hand in hand.

Better information is clearly going to be vital to those planning medical careers. The close tracking of medical school admissions and graduate specializations can be combined with data on paraprofessional jobs to give potential entrants a picture of where, and how, they might best use their skills to achieve a reasonable income. In sharp contrast to a few years ago, today medical specialists are represented in most cities and many towns as a new Rand study has shown.

As competition, based on better information, develops at the local level, providers may begin to see some reluctance on the part of the community to pay excessively high costs for health care. As a result, a more dynamic sense of supply and demand could be developed to the benefit of everyone.

Furthermore, patients of the future will know how to use computers. Many will have learned these skills on the job, in our corporations. Their children will study computer programming in school. Most will have home computer terminals of some type, giving them access to assorted health care information and programs.

Informed patients will certainly keep the providers of medical service on their toes. The future consumer of medical care will, like Pac Man, be able to ingest a huge amount of health information. No longer will the latest medical or pharmaceutical breakthrough be covered only in professional literature. For example, starting June 30, American TV viewers will be able to tune in a Cable Health Network, 24 hours-a-day, seven days-a-week. Patients and their families will be able to gain helpful knowledge of alternative treatments and their costs and the way other communities are attacking their problems.

The business community will be in the forefront of this information drive. We all process and disseminate information of one kind or another. It's something our companies do well. Today many of our medical directors could use corporate electronic mailing devices to deliver general health information to all employees, as well as sending pertinent and confidential medical information to those employees who need it.

The impact of an educated mass of employees on U.S. health care could be quite remarkable as this knowledge works its way through the general population. And work its way through, it will. Our employees--who have learned CPR, who understand the necessity of healthy diets, who know about cost effective treatment and the availability of facilities such as hospices and satellite surgical centers--will carry this information to all segments of society.

Their voluntary work with social agencies, religious organizations and their travel around the country will ensure its spread.

If we can give them additional data about how they can get quality care at the least cost, this informal employee information network can quickly turn itself into a vast consumer referral network.

Today's trends--changing demand, changing supply and rapidly changing patient attitudes-- have already impacted the delivery of health care. Our concern as business managers is to help guide the health care delivery system through all of these changes toward a more cost effective balance--a balance based upon each participant having access to information. Only then can we, as corporate consumers, payers of premiums, and tax payers, start to feel that we're getting the maximum value for our dollars.

I'm not convinced that increased regulation of health care would permit the positive trends I've mentioned to continue. Regulations tend to move the problem around--shift the cost from one place to another, but do little to solve the overall problem. I think we can best encourage these trends through the marketplace decisions we make--both while wearing our corporate hats and as individuals, working in our communities.

We must work cooperatively with all levels of government as well. Agencies will continue to be major purchasers of care for millions of our citizens. Our interaction and service with these agencies can help them move toward a cost effective allocation of resources.

Above all, now that we have gotten the attention of senior corporate management, let's make sure that we all use the information already available to purchase health products and services wisely.

Thank you for your hospitality. I want to wish all of you well in carrying forward the WGBH agenda in 1982. The Business Roundtable appreciates your partnership in helping us carry this message to our memberships.

  • The document was created from the speech, "Remarks at Washington Business Group on Health Annual Conference," written by Walter B. Wriston for the Washington Business Group on Health Annual Conference on 23 June 1982. The original speech is located in MS134.001.005.00002.
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