Procrastination - A challenge to Healthcare.

We all agree that providing health insurance coverage for many more Indians than today is one of the most important economic and social imperative.  Fewer than 5% of healthcare expenditures are covered by health insurance with almost two-third of healthcare costs being out-of-pocket expenses.  The focus currently is on hospitalization expenses with very little importance given to preventive care and chronic disease management.

But, what has preventive healthcare and health insurance got to do with procrastination?   

Procrastination (Latin meaning “for tomorrow”) can be one of the root problem for higher healthcare costs.We promise to have our health checked regularly, but cancel our appointments. We procrastinate. How much do we lose when our transient impulses deflect us from our long-term goals? How much is our health affected by those missed appointments and our lack of exercise? We lose our fight against procrastination frequently.  

Our strong emotions grab hold of us and make us give-up long-term goals due to instant and short-term gratification.

Healthcare – Preventive medicine is generally more cost-effective than our remedial approach. Prevention means getting tests done on a regular basis, before problems develop.  While, our long-term goal of health and longevity depend on preventive health checks, we procrastinate. Suppose our doctor tells us that we need to get the cholesterol checked. That means, fasting the night before, getting up early and drive to the nearest lab without breakfast, waiting in the crowded reception and have the person stick the needle into our arm. So unpleasant stuff, and the outcome, we begin to procrastinate. The check never gets done.

So, how do we fix this problem?  The events that transpired during our school days should possibly provide one solution.  At school, procrastination was never in our dictionary for all important projects. The reason, we were set deadlines which were self-imposed and had penalties attached. A kind of dictatorial solution, but was very effective. We made pre-commitments that helped us from falling for temptation for procrastination.  So, the most obvious solution for our health check-up problem is to have an authoritative “external voice” giving us orders. We could have a dictatorial solution, in which someone would enforce us of such health check-ups. Coming back to the doctor’s case above, what would happen if the doctor charges you an upfront fee - say Rs.10,000/- (a penalty), and puts a condition this is refundable subject to you being there for the appointment on time. Would we accept this condition? Most of us will.

Can Health insurance companies enforce us to health check-ups and disease management? How can they influence us to adhere to such self-imposed deadlines? Would this be one of the many solutions to avoid procrastination?

How else to defeat procrastination? We can look back to a story involving maintenance of our car for some inspiration.

Several years ago, Ford struggled to find the best way to get their car owners back in to the dealerships for routine maintenance. The problem was that their cars had some thousand’s of spare parts and they did not require servicing at the same time. Some parts needed more frequent maintenance compared to others. But, the Japanese giant Honda had some mechanism by which more consumers visited their dealerships for maintenance. Even a Honda, had similar challenge with several thousand’s of spares and not all needing maintenance at same time. How did Honda manage to do this? In fact, they had aggregated all the maintenance schedules into intervals (for instance, first 6 months or 5,000 kms, 1 year or 10,000 kms etc.). All the hundreds of service activities were boiled down in to simple, mileage-based activities that were common across all vehicles. They were bundled, sequenced and recorded. Anyone could see when the service was due and more important, how much it would cost. We all are used to this today and the maintenance activity has become extremely simplified.

We have done this for our cars, why not health?  Can we bundle our medical tests so that people remember to do them? If we repackage most of our medical procedures so that they were predictable, simplified and easily done, procrastination can be avoided.