. "1 The Role of Purchasers in the Clinical Research Enterprise." The Role of Purchasers and Payers in the Clinical Research Enterprise: Workshop Summary. Washington, DC: The National Academies Press, 2002.
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in which the individual makes lifestyle decisions, they will not be able to reinforce the switch to healthier behaviors.
George Isham, M.D.
Medical Director and Chief Health Officer
Prevention is a cost issue for employers as well. For example, employees at the extreme of the body mass index chart, at 35 or 40, may incur substantial costs associated with bypass operations needed to treat heart conditions related to diabetes. The expenditure for operations such as these is so large that it over-whelms all existing preventive budgets.
Many links that are known to be associated with overweight have no good studies, however, and funding is not forthcoming. There is an extreme dearth of funding for health promotion and disease prevention. Employers are encouraged to use whatever language is required to promote interest in this issue, and they are encouraged to pursue the appropriate funding of not only the obesity issue but also the activity issue and the tobacco issue.
Myrl Weinberg, C.A.E.
National Health Council
In this meeting and in many others, there is much discussion of the increasing role of the patient or consumer in influencing the health care system and the delivery system, particularly with respect to what health care is provided. In nearly every case, however, when meeting participants discuss convening groups of stakeholders to identify problems, examine the challenges, set priorities, and come up with solutions, they mention every stakeholder except the consumer or patient. Discussion often centers on shifting costs to the consumer or patient, or potentially shifting decision-making responsibility to them, but very little is said about working together with them on these issues. When an employer has the primary responsibility for the health care decisions for its employees, these employees should be included the design of the plan.
Thirty years of health policy in this country has shown that it is difficult to identify consumers or a consumer. Good literature exists to guide proper selection when employees wish to involve consumers in decision making. Large- and medium-sized employers do much surveying of their employees. Most employ