On the basis of the scientific research already conducted on the Transcendental Meditation program, as well as the cost-benefit analyses provided above, we suggest that national health initiatives should make provision to reimburse training in proven prevention-oriented programs such as the Transcendental Meditation program. Intermediate options might also be considered, e.g., targeting hypertensives and high health-care Medicaid participants, as in the example cost-benefit analyses above. The available research suggests that, ultimately, the most effective long-term approach would be to make the Transcendental Meditation program an integral part of health education programs in the nation's schools.
In addition to the Transcendental Meditation technique, Maharishi Ayurveda encompasses several other proven, cost-effective prevention methods that could also be included as part of a comprehensive health education program. Innovative health education programs, such as the Transcendental Meditation interventions described above for minority and elderly populations, could empower individuals to take fuller responsibility for their own health, rather than giving the physician that responsibility, as is currently the case in society. Future research should therefore include the development of innovative health education programs that will enable citizens to make use of health information in a more practical and useful way.
An effective national health care policy must address both price containment (through managed competition, price control, and other methods) and reduced utilization of medical services. Breslow (1990) and numerous other public health experts estimate that the majority (80%) of diseases and accidents are preventable through known methodologies; yet at present there is an imbalance in the funding of medical research, with only 1%-2% going to prevention and 98%-99% spent on curative approaches. One rationale for neglecting prevention is the lack of evidence to support its cost effectiveness. Therefore, a first step in overcoming this lack of documentation would be to redirect more resources toward prevention research. To achieve this end, specific grants should be made available to conduct rigorous, well-controlled studies to evaluate the possible health and financial benefits of prevention. It would be especially valuable to conduct intensive research that would evaluate the impact of effective health promotion and disease prevention on high-cost individuals, because as mentioned above, this small fraction of our population incurs the majority of medical expenses in our nation. Research directions should include studies on the effectiveness of various approaches that enhance health and prevent disease and that might also be cost effective.
Since a substantial body of research indicates that most disease can be prevented by living healthier lifestyles, future research to identify and develop effective methodologies to change unhealthy behaviors should be given top priority. For example, cigarette smoking accounted for nearly 434,000 deaths in 1992 and cost over $100 billion in medical treatment expenses for those who died. Effective smoking-prevention programs for the young as well as smoking-cessation interventions for adults could thus save many more lives than are lost through genetic disorders, for example, although those diseases are allocated significantly more funding for research. For example, several research studies examining the effects of the Transcendental Meditation program on cigarette and alcohol consumption have validated the effectiveness of this intervention in reducing and even eliminating these behaviors.
Finally, on a collective level, over 40 scientific research studies have indicated that group practice of the Transcendental Meditation and Transcendental Meditation-Sidhi program by a relatively small proportion of a population reduces societal stress, leading to significant reductions in violent crime, drug abuse, and other antisocial behavior (see, for example, Dillbeck et al., 1987; Orme-Johnson et al., 1988a; and Orme-Johnson et al., 1988b). Funding to allow the formation of such groups would therefore not only improve collective health, but would also improve the overall quality of life for all Americans.
Through the implementation of prevention-oriented interventions such as those described in this paper, the health status of the United States should no longer remain among the worst of the developed nations. The goal of improving the health of U.S. citizens while reducing medical expenditures is feasible today through intelligently applied programs of expanded and effective preventive care.
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[The International Health Care Cost Crisis]
[The Need For Prevention: Identifying New, Cost-Effective Strategies]
[The High-Cost Case Phenomenon: A Way to Leverage Medical Expenditure Savings through Prevention]
[The Proposed Strategy]
[Conclusions and Future Research Directions]