A survey of the news over the past few weeks tells me the incidence of diabetes increased to 366 million people world wide. Stents continue to be performed after studies show they do not improve patient outcome. One third of Medicare and Medicaid dollars are wasted with mistakes and errors. A gross percentage of health care dollars are swallowed up by the insurance industry.
In our current “treat after the fact” medical system, prevention gets little attention or monetary support. When lifestyle intervention is warranted, nutrition services are routinely denied by third party payers or the coverage is intensely limited.
HOW DOES THE PUBLIC ACCESS A DIETITIAN?
Medicare pays for nutrition support of diabetics and people with renal disease. No nutrition support for cardiovascular or gastrointestinal diseases. No support for medical nutrition therapy for cancer and other diseases impacted by nutritional status.
Private insurers are even more difficult to deal with. Some insurance companies accept dietitians as providers. They are paid a fraction of their usual fee.
Mostly insurers deny payment because few have formal underwriting to cover nutrition services. Patients are forced to appeal a denial and ask for medical review. Reviewers are paid based on the number of claims they deny. Very few clients tell me their visits are covered.
As a registered dietitian I observe the conundrum with dismay. People are overwhelmed with our current food supply. It is abundant, adulterated, and often the cause of disease. We are wired for surviving scarcity. We do not yet know how to survive abundance.
PEOPLE NEED MORE HELP WITH DIET, NOT LESS
Avoiding a poor diet takes great skill and discipline, in addition to a healthy wallet. In a quick survey at a local market, it is possible to purchase 100 calories of foods mostly made with sugar, refined starch and added fats for pennies per 100 calories. Fruits and vegetables cost multiple times more.
ACCESS TO NUTRITION SUPPORT IS ONLY THE FIRST HURDLE
Dietitians are not given the opportunity to do their best work.Too many dietitians see clients for 15-20 minute visits. Many dietitians tell me that follow up visits are not routine. At one large health care organization most nutrition related classes are not even taught by a dietitian. A nurse teaches the diabetes and cholesterol classes and can’t answer the food questions.
No wonder many people complain that they find nutrition services inadequate. Knowledge is not behavior. Education is a first step, but is not necessarily enough to change behavior. Health care dollars are not available to address the life style issues that can make the most difference.
Our food supply is adulterated and abundant. The government continues to subsidize crops that make highly refined starches, sugar and added fats very cheap. There is no one right way to eat. How are people supposed to figure out an approach to food that works?