David S. Sobel MDThere are two basic factors in the medical cost equation: 1) the number of people using medical services and the frequency (medical utilization) and 2) the amount of money paid for the services (expense). To date, most efforts to reduce medical costs have focused on impacting the equation by limiting access to care or reducing the payments to physicians and hospitals. There is another approach however, one which would improve health at the same time: reducing the actual need and demand for care.
This approach does not mean dissuading those who are truly sick from seeking care. In fact, physical illness is not a good predictor of medical utilization and expense. Many people with disease do not seek care, while others with little apparent disease tend to visit the doctor frequently. The decision to seek care is more determined by anxiety, worry, stress, lack of confidence, lack of information, job dissatisfaction, and unhealthy lifestyles than it is by the presence or absence of physical disease. Therefore, it is reasonable to think that mind/body interventions which address the underlying distress that prompts visits to physicians, might reduce distress and medical expenses.
A recent, preliminary study in Quebec, Canada suggests that the practice of one common such mind/body intervention meditation and relaxation may indeed reduce the cost of physician services. The study focused on Transcendental Meditation (TM), a practice introduced by Maharishi Mahesh Yogi which involves focused concentration and relaxation for 15 to 20 minutes twice daily. This practice tends to produce physical and mental effects that are opposite to the stress response.
In this study, payments to physicians were analyzed for 677 patients practicing TM. For the three years before starting to practice TM, adjusted payments to physicians did not change significantly. After beginning TM practice, patients expenses tended to decline 507% annually.
These impressive results must be viewed with caution. There was no comparison or control group. The patients chose to start and continue TM practice and elected to participate in the study. Therefore, it is unclear whether the results would apply to other groups of people.
Unanswered Questions
What led to the reductions in physician costs? Less stress? Increased self-confidence and less dependence on professional medical care? Improved health habits such as less smoking and substance abuse or better diet and exercise? A shift away from conventional medical care to alternative medicine?
Do the findings only apply to the use of TM or to other daily meditation, mindfulness and relaxation practices?
Even with these questions still to be answered, the preliminary results of this study suggest that mind/body interventions hold real promise for improving health and reducing costs.
For More Information:
Herron RE, Hillis SL, Mandarino JV, et al: The impact of the Transcendental Meditation program on government payments to physicians in Quebec. American Journal of Health Promotion 1996:10:208-216.
Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.
