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A Critical Component of Health Care Reform

Stephen M. Shortell, PhD, MPH, MBA

JAMA. 2009;302(11):1223-1224.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The estimated 10-year cost (2010-2019) of expanding health insurance coverage is at least $1 trillion. New revenue sources will not cover this cost. Thus, to make such coverage affordable, it is necessary to "bend the cost curve" in the rate of annual increases in health care spending, which in most years has significantly exceeded the overall rate of inflation. This will require addressing the underlying determinants: primarily the behavior of patients, hospitals, and physicians as they use available technologies and treatments.

Prevention, Patient Behavior, and the Community

Disease prevention initiatives aimed at improving nutrition, physical activity, tobacco use, and related lifestyle behaviors are likely to have the greatest effect on slowing the annual increase in health care costs. This is because they have the largest influence on reducing the future burden of disease, particularly in regard to obesity and the sequelae of diabetes, heart disease, and cancer.¹

Evidence suggests that . . . [Full Text of this Article]

Author Affiliations: Division of Health Policy and Management, School of Public Health, University of California, Berkeley.

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