Holistic Self-Care: Bang for the Buck?

摘要

There is no doubt that the Affordable Care Act is driving health care in new directions; the integration of behavioral health into primary care; the move from acute to ambulatory care; primary care for seniors in the home delivered by nurse practitioners; an emphasis on nutrition, exercise, and other forms of wellness interventions to maintain and improve health; and a focus on the value of care through the documentation of outcomes. It will be interesting to monitor expenditures on care over the next several decades as the system adjusts. For example, in 2007, $2.2 trillion was spent in the United States on traditional health care including procedures, devices, drugs, and doctors’ visits.1 Of this staggering amount, $2.86 billion was out-of-pocket expenditure—surgical procedures and drugs not covered by insurance, concierge medical practices, and other treatments prescribed by conventional providers but not covered. In the same year, US citizens spent $33.9 billion, out of pocket, on CAM (complementary and alternative medicine) therapies: $22 million on self-care products such as nonvitamin and nonmineral natural products and a variety of holistic practitioners. These expenditures constitute 11.2% of total out-of-pocket health care expenditures, conventional and CAM. The remaining $11.9 billion was spent on visits to CAM practitioners such as massage therapists, chiropractors, acupuncturists, holistic nutritionists, yoga masters, and those who teach meditative techniques. To illustrate the power of Eastern self-care modalities, $4.1 billion was spent on yoga, tai chi, and qigong.