Why we need better-value health checks

Employee health checks too often seem to be about marketing and income generation, especially in the private and insured sector. We need a model that is better able to articulate why a health check is needed and what value will be gained from it, both for the individual and organisation, argues Dr Nick Summerton.

Having a health check is not cheap. According to Nuffield Health, its 360 Health Assessment (at time of writing) costs £564. Moreover, in addition to the basic price of the health check, it is often necessary of course to take time away from work both for the initial assessment and any follow-up required.

In this context, it is important to ensure the health check is delivering good value for individuals and organisations. However, in scrutinising many existing health check packages or commenting on proposed new developments, I have often struggled to identify the health-related purposes of the individual components and, on some occasions, the package as a whole!

Not infrequently it appears as if the primary purposes of health checks developed by the private sector (including some insurance companies) are more associated with marketing, income generation and immediate customer satisfaction than with longer-term wellbeing.

Linked to this there is often considerable emphasis on issues such as the use of advanced/innovative technologies, the length of time the assessment takes, the numbers of tests being offered together with the comfort and facilities of the screening environment.

On the other hand, carefully designed health checks ought to represent high-value care with improved outcomes and reductions in costs. For example, sound research evidence demonstrates that detecting early stage bowel cancer is associated with improvements in survival plus lower levels of subsequent physical and psychological disability.

Direct health care costs are also lower (because of less complex/invasive treatments) and with less financial burden on individuals, families and employers due to faster recovery and less time off work.

Better understanding of outcomes

My recent book Better Value Health Checks: A Practical Guide (and while this article is not intended to be plug, do see the reference below) examines the issues to be considered by organisations or individuals wanting to purchase or procure a package that will actually make a difference to health and wellbeing.

A better value health check is one in which each element of a health check from the choice of the components, the way they are delivered in addition to the pathway after the clinical data collection have been carefully considered with outcomes and costs in mind.

Furthermore, the outcomes need to encompass not just what seems to be important to doctors and nurses but, in addition, what matters to those having a health check. High-value care is about achieving maximal benefit and minimal harm (physical, psychological and financial) in the context of a particular person’s values and priorities.

Based on my book I have now developed an accreditation framework that enables health checks to be graded A, B or C using the following key questions:

1. Is the health check based on need?
2. Is the health check outcome-oriented?
3. Is the health check cost conscious?
4. Is the health check evidence-based?
5. Is the health check Information focused?

For example, in relation to the question around need, the approach to ranking could be as follows:

Key question:

Is the health check based on need?

Detailed criteria:

• Do the constituent elements of the health check reflect local prevalence/incidence data on diseases/disorders? [Yes = 2 (all elements); Yes = 1 (some elements); No = 0 (no elements)]
• Does the health check seek to addresses some aspects of inappropriate variations in practice? [Yes = 1; No = 0]
• Overall is the health check relevant to the health concerns/values of employees? [Yes = 1; No = 0]
• Has consideration been given to the quality (in other words accessibility, acceptability, appropriateness, efficiency and effectiveness) of any current prevention and earlier disease recognition services already available to individuals [Yes = 2 (all elements); Yes = 1 (some elements); No = 0 (no elements)]

Grading:

A: more than 5

B: 3 to 5

C: less than 3

By focusing on better value health checks in this way, the emphasis moves away from operational discussions about the process of health checks to the actual health benefits – or outcomes – achieved.

I emphasise that, for individuals, I am in no way suggesting denying, dissuading, or deterring then from having a health check. Rather, this is about finding ways to divert them to a new model where the value, need and outcome of the health check are better defined and understood.

• Better Value Health Checks: a practical guide is published by CRC Press, part of Routledge, and is available online or from good bookshops.