In this blog, I will make the case that Implicit Type Architecture is the foundation of a new health psychology of both health and illness.  I predict that it won’t be long before health professionals, practitioners, therapists throughout the US and internationally will be wondering why they didn’t see this all along! As this blog progresses, the foundations and effects of ITA on adaptive patterns to health and wellness will be explored and revealed, and used to address a range of health conditions, diseases, and patterns of optimal health. Please join me!

She likes those preventive check ups.

I bet lots of you who read the above title think my comments will be about adults who smoke, or adults who are obese because of over-eating and poor diet. Well, to me these adults are easy targets. They are the low hanging fruit because they are easy to spot, and easy to point the finger at.

But things like overeating or smoking are not the adult behavior I am concerned with. The patterns of behavior I am describing are responsible for about $20.8 billion in unnecessary excess medical spending every year. The spending is unnecessary because the excess medical costs are less related to medical illness and more related to a certain type of person who trusts doctors, engages in proactive health behavior, and owns an extreme readiness to seek medical care.

How the Most Expensive Patients Behave and Think

The description of health behaviors and predispositions that follow come from research I have conducted through the PATH Institute Corporation. The 20 health related statements listed below come from the PATH Type Questionnaire and are used to describe the behavior and predispositions of the most expensive patients. The tailored statements come from interviews with just under 14,000 adults between the ages of 18 and 65 who have health insurance. The adults with this pattern of health behaviors and predispositions generally account for about 15% to 17% of health plan members, but only make up about 10% of adults nationwide.

Here is how they describe themselves:

• I look for health information
• I do not choose doctors to try and save money
• I always plan ahead for my health
• I am not concerned with trying to save health care dollars
• I don’t take part in vigorous exercise or sports
• I make health care decisions for the family
• I don’t like or dislike making family health decisions
• I go to the doctor, and I don’t worry about the costs
• My family members take care of their own health
• I would not compare hospitals if I needed to go to one
• I look for information about nutrition and dieting
• I go to the doctor at the first sign of any problem
• Most doctors are competent
• When I get sick, I mostly decide treatments myself
• I would like my family to be healthier
• I feel that I try to keep my body in top physical shape
• Most doctors are thoroughly informed about the drugs they prescribe
• I prefer to not use the doctors who are the least expensive
• When I get sick I go beyond the treatments my parents used to use
• I’m pretty much make my own health care decisions

Who They Are

Here are a few characteristics of these adults who describe themselves this way based on data from over 250,000 adults:

• About 70% are female
• Average age about 52, but there are plenty above and below this age
• Typically very well-educated
• High income or affluent
• No children or older teens
• More often married or divorced
• Self rated health status moderate to somewhat low
• Activity level moderate to somewhat low
• Many self-reported health risk factors
• Highest number of diagnosed diseases
• Highest rate of prescription drug use
• Above average rates of medication compliance and adherence

My Purpose

I am describing this group of adults because they are responsible for a large share of unnecessary medical spending which needs to be recognized and reduced with the same kind of focus given to smoking behavior and the growing national focus on obesity.

The adults with the characteristics, behaviors, and predispositions I have described drive up the treatment costs for every disease and illness unnecessarily.

Based on what I have seen in many years of data, the failure to recognize the impact of these adults defined by psycho-behavioral predispositions will hamper any and all efforts at reducing healthcare costs throughout the United States, and are likely to contribute to a bankrupt outcome for any health care delivery system adopted.

It is very unfortunate that there are people who won’t or can’t take care of themselves. I don’t mind the people who can’t.

Neurocognition and schemas

Schemas are patterns used by your brain to function efficiently. They are formed by your experiences and the way you react to similar situations.

Your brain activates these schemas to help it respond efficiently to stimuli with the least amount of thought. Your brain can activate schemas appropriate for a given situation before you are aware the situation is present. This means you start reacting to a situation unconsciously. When schemas include instructions to turn on emotional centers you will have strong feelings.

Now, schemas draw on your many memories, but reduce them to so that the same behaviors can be applied to other situations. When you go to the store, a schema gives you all the steps you will need to go the store by recalling memories of all the times you went to the store before. These memories include all of the “movement memory”, and emotional memory as well.

Here is a statement describing a possible schema around health:

“I always look for information about nutrition and healthy dieting.”

This statement is like a schema because it describes what you do, but it does not describe a specific memory of something you did before.

OK, so how are schemas related to behavior and health?

Look at the statement above and ask yourself how strongly it describes you.  Do you strongly agree, strongly disagree, or something in between?

In a national study of 65,000 people across the U.S. it was found that agreement with this statement increases the number of diseases a person has.