The Health Care Cost Crisis and
the Role of Prevention:
New Approaches Utilizing the Transcendental Meditation Program
Robert Herron, Ph.D.
University of Management
Fairfield, Iowa, U.S.A.
(Originally published in Modern Science
Vedic Science Volume 6, NO. 1, p. 33-59)
During the past two decades, the United States has become increasingly concerned with reducing medical care expenditures while continuing to improve the health of Americans. However, medical costs have continued to rise rapidly, despite efforts to contain them. Unlike the treatment-based strategies for health care that are currently in wide use, prevention-oriented approaches offer great unrealized potential to directly improve the health of U.S. citizens and thereby to reduce medical utilization and its attendant costs. At present, however, there is little research to validate the cost effectiveness of such prevention programs.
This paper reviews the cost effectiveness of the current U.S. health care system as compared with those of other nations, especially Canada, and examines the potential of effective prevention programs for alleviating the health care cost crisis. A strategy is suggested to lower medical care utilization and expenditures by directing effective health-promotion and disease-preventive interventions toward the highest-cost patients-that fraction of the population that consistently incurs the majority of all medical expenses. The scientifically validated Transcendental Meditation program is proposed as an effective preventive intervention to accomplish this strategy, and pertinent health-related research on the Transcendental Meditation program is reviewed. Future research possibilities are also suggested in order to enhance and expand national preventive care and thereby to further reduce high medical expenditures in the U.S.
Despite numerous attempts by many governments to contain accelerating costs in the health care field during the past two decades, medical expenditures have continued to grow rapidly as a percentage of gross national product (GNP) throughout the world. This escalation diverts resources from other important national and international goals, such as job creation, housing, education, economic development, and the environment. In recent years, the medical expenditure crisis in the United States has created growing alarm about the efficiency and equity of the U.S. medical system. Jencks and Schieber (1991) summarize the problem:
Although U.S. health care costs have been in a proclaimed crisis for 10 to 20 years, we have made strikingly little progress in containing the growth of these costs. Neither the "regulatory" policies of the 1970s nor the "competitive" policies of the 1980s have slowed the growth of health care spending. (p.1)
Although medical expenses are higher in the U.S. than in any other country, the cost crisis is not limited to one nation; it is a worldwide problem. Moreover, the medical expenditure challenge is noncyclical; it continues to grow worse with time. Consequently, new and innovative interventions in the health care field will be required to slow this growth and, ultimately, to decrease medical spending.
Present cost-containment efforts focus mainly on attempting to improve the financing, delivery, and administration of the medical system. This type of improvement so far has had limited results (Jencks & Schieber, 1991). Medical spending is still escalating, yet many measures of health are not improving; indeed, some are declining. For example, the cancer rate is increasing in most developed nations in spite of significant funding for medical treatment and research. Such data suggest that current cost-containment strategies will inevitably fail in the long term if they do not address the underlying causes of the health care problem (Schwartz, 1987). Policy makers can no longer rely solely on administrative, financial, or treatment-oriented strategies to reduce medical expenses. New strategies are needed to prevent disease and enhance health, and thereby to reduce medical payments.
Most traditional preventive interventions, such as pure water and food, hygiene, and vaccination, have been fully exploited in the developed countries. Hence, further investment in these types of prevention is unlikely to yield significant improvements in national health and reductions in medical expenses. Other preventive approaches, however, offer great unrealized possibilities. These include lifestyle change, stress reduction, and environmental improvement. The U.S. Department of Health and Human Services (1990b) conducted an exhaustive analysis of the research on the benefits of prevention and concluded:
Recent evidence confirms that better control of fewer than 10 health risk factors-for example, poor diet, infrequent exercise, use of tobacco and drugs, and abuse of alcohol-could prevent between 40 and 70 percent of all premature deaths, a third of all cases of acute disability, and two-thirds of all cases of chronic disability (p. v).
These figures represent a large potential cost savings and a significant reduction of suffering. They suggest that the underlying cause of high medical utilization and hence expenditures is poor health. Yet research consistently shows that most disease is preventable through known methodologies (Friend, 1992; Breslow, 1990). If the implementation of such methodologies led to better public health, then medical financing, administration, technology, and delivery issues would become less important.
A renewed focus on prevention thus seems essential in order to alleviate both the health care cost crisis and unnecessary human suffering. However, many prevention interventions have been found to be expensive (Russell, 1986). Therefore, it is also essential to find cost-effective methods of health promotion and disease prevention.
The Transcendental Meditation Program: An Overview
Several lines of research indicate that one recently introduced method, the Transcendental Meditation (TM) program, can be particularly effective in reducing health care costs through effective disease prevention and health promotion. Moreover, existing data on this technique indicate that it is particularly effective in reducing health care costs among high health-care utilizers, the 10% of the population responsible for over 75% of national health care expenditures (Garfinkel et al., 1988).
The Transcendental Meditation technique is the primary intervention of a comprehensive system of health care known as Maharishi Ayurveda, which includes 20 distinct approaches to health promotion and disease prevention. This system is the authentic record of the ancient natural medical system of India. During the past decade, Maharishi Mahesh Yogi, founder of the Transcendental Meditation program, has initiated and collaborated on extensive research to bring to light the principles and practices of this ancient system of health.
Transcendental Meditation is a simple, effortless procedure, normally practiced for 15-20 minutes in the morning and evening sitting comfortably with eyes closed. The technique can be learned by anyone, independent of their educational, religious, or cultural background.
Twenty years of scientific research have shown that the Transcendental Meditation program is highly effective in alleviating many stress-related diseases and lowering the associated high rates of health care utilization and costs. These studies, several of which will be described below, have shown Transcendental Meditation to be a practical preventive program in a wide variety of populations, including inner-city African American and elderly groups.
Over 500 scientific research studies examining the effects of Transcendental Meditation on mental, physical, and social health have been conducted to date (see Orme-Johnson and Farrow, 1976; Chalmers et al., 1989; and Wallace et al., in press). Published meta-analyses-the most rigorously objective method of reviewing scientific literature-have found that the Transcendental Meditation technique produces:
1. a psychophysiologically unique state of restful alertness that is different from simply resting with the eyes closed (Dillbeck and Orme-Johnson, 1987);
2. greater reductions in anxiety than other meditation, relaxation, and stress management techniques (Eppley et al., 1989);
3. greater improvements in positive mental health (self-actualization) compared to other techniques (Alexander et al., 1991).
The research further indicates that regular practice of this technique restores balance in the mind and body and provides the basis for accumulated health benefits.
Numerous published studies have documented that the Transcendental Meditation program prevents and reduces such major health problems as cardiovascular disease, substance abuse, mental disorders, and cancer. In addition, there is strong evidence for slowing or reversal of the aging process and enhancing human performance in many areas. These disease prevention and health promotion effects have resulted in 50% or greater reductions in health care utilization and health costs in several populations.
In this paper, we present an analysis showing how a relatively small investment to train high-cost health care patients in the Transcendental Meditation technique would result in a surprisingly large reduction in national health care expenditures. We first review the escalation of medical expenditures in the U.S. and compare the U.S. medical system with those of other countries, notably Canada. Then we discuss the high-cost case phenomenon and the potential application of the Transcendental Meditation program as an effective intervention for this segment of the population. We also summarize the pertinent research studies concerning the impact of the Transcendental Meditation program on health. Next we present a cost-benefit analysis of potential health care savings through the Transcendental Meditation program, using the Washington, D.C. Medicaid program as an example. We conclude with suggestions for future research aimed at improving the health care cost crisis in the U.S.
[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]