Healthcare vs. Health Care

May 31, 2020

Well, it’s finally happened. Mr. HisTalk and I violently disagree. His note today includes:

Re: journalistic style. Is it ‘health care’ or ‘healthcare?’” I use the rules of the “AP Stylebook” for journalists with few exceptions, but one of those is that I write “healthcare” as a single word. I don’t have a strong feeling either way , but the one-word variant saves space without sacrificing (although I acknowledge that (“medicalcare” or “hospitalcare” don’t work).

For reference – see the HHS web Style Guide:

Health Care
Not healthcare, except on an agency or organization title.

And in this insightful note from Jodi Amendola (with which I mostly agree):

Healthcare versus health care

The difference between these two terms is about more than house style or personal preference. The term healthcare–one word–refers to an industry and the system of providers within it. But health care–two words–is about improving health and caring for people, especially when it comes to treating populations. The current trend toward population health is about making communities healthier by supporting preventive care and wellness. The goal is to provide health care–in order to keep people out of the healthcare system.

And while I can’t deep-link to the AP Style Guide (paywall) … they offered a tweet about this almost exactly two years ago:

APStylebook

@APStylebook
We’ve changed our style to one word for “homepage.” We added “smartwatch” and “timeshare” as one word. But: “health care.” #APStyleChat

412
2:55 PM – May 30, 2018
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228 people are talking about this
So Mr. Histalk’s rationale is that he “saves space without sacrificing.” I’d argue that he sacrifices quite a bit.

I’ll also offer Victor Galli’s remarkably thorough summary of the topic and his equally remarkably illogical conclusion that “healthcare” is preferred:

The short answer is that “healthcare” has taken on more meaning as a closed compound word to describe the system/industry/field than is captured in the two separate words “health” and “care.” “Health care” does not sufficiently capture the increasing demand for nuance and specificity in referring to topics surrounding the practice and facilitation of services to maintain or improve health. Healthcare represents the political, financial, historical, sociological, and social implications of a system that provides health care to the masses.

I disagree with Jodi and Victor that “healthcare” refers to an industry and a system of providers, though this opinion often appears when one does a google search on this topic. I also disagree with Jodi that “the goal is to provide health care.” No. The goal is to improve health. Sometimes the way we do that is to provide medical care, but let’s not assume this is the only way to improve health. Indeed, we know it’s not.

But I agree with most of what Jodi writes and her conclusion is spot-on: words matter.

I don’t believe that “healthcare” should be used at all. There are many (better) ways to describe the industry: the people, the providers, the practitioners, the care delivery organizations, etc. Indeed, lumping this all together, as Victor argues, loses the nuance and specificity that these other terms express.

Stepping back …

Definition of health from the WHO

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

of the 16 definitions of care from Merriam-Webster, these are most relevant:

: regard coming from desire or esteem
a care for the common good

:CHARGE, SUPERVISION
under a doctor’s care

: a person or thing that is an object of attention, anxiety, or solicitude
The flower garden was her special care.

: to give care
care for the sick

So it’s clear that health and care are different. Alone, this isn’t reason to avoid a neologism. Indeed, many words do just that woodpile, headache. As Victor notes above, a closed compound word is one that combines two things (usually nouns) that now assumes a new meaning by itself: basketball, keyboard, popcorn. I’ll acquiesce that if folks are arguing that “healthcare” is a benign compound word that describes an industry, they’re grammatically correct. But we choose not to use many words and phrases that are grammatically correct. (I’ll avoid the hot water that a few examples here would get me into.) Grammatical correctness can’t be only bar; the words need to help us say something meaningful.

Indeed, the words we use convey the world we see (or the world we wish to have).

Words matter.

Let’s look past the naiveté of “benign compound word.” This is the point that Victor and Mr. HisTalk seem to miss: when we separate the words, we share an important message, reminding ourselves and those with whom we communicate that health and care are not synonyms. As a physician, I see the semantic conflation every day in my peers and (sadly) in our medical students and residents. One of my hypotheses is that it is the very egocentrism of our profession(s) that cause us to conflate health with care. If people could be healthy without us – what are we here for? We remind ourselves (and our communities) of our importance by suggesting that care is a necessary precedent of health.

“Of course we don’t do that” you say …

Consider the so-called “annual physical exam.” This is well documented (summaries here, here and here) to increase the quantity of care, yet cause no positive health improvement. Yet its tradition has taught generations that more care = more health. Think about the phrases we use: (that Covid-19 is making us reconsider) … “come back to the office if you’re not better in 2 weeks.” “I can’t refill your prescription because you haven’t had your annual physical.” “It’s probably nothing but I need to do some tests so let’s schedule one office visit for the tests and another to discuss the results.”

This is “healthcare” – the compound word. In connecting these concepts linguistically, we propagate the flawed principle that care causes health, and while care may in many cases be necessary, our goal is better health. There are many examples of how more care is not more health. Great health economists and health journalists have documented this eloquently.

We have evolved language to reflect our evolving (improving?) sensitivity to race, religion, sexual preference and gender. For example, when I am careful to clarify or seek clarification of preferred gender pronouns, I send an explicit message of my awareness of the importance of these preferences to many people. It’s a movement. When we all do this, we remind each other to move past our decades of assumptions so that we can speak (and think) in a manner that is inclusive and respectful.

So the separation of health and care is a similar movement. It’s a linguistic statement that reminds us of a policy goal: these are different concepts and they must be separated culturally, politically and economically. If we are successful in doing so, we’ll make different (better) decisions that will improve health and reduce unnecessary care.

This is why it’s so important to cleave “healthcare.”

ABOUT THE AUTHOR

Jacob Reider MD, FAAFP
CEO Alliance for Better Health

I am here because I want the world to be more healthy. I have worked for decades to improve the health of our communities through the innovative use of technology, and the promotion of benevolence in business. I am currently CEO of Alliance for Better Health, a New York DSRIP care transformation initiative, Chief Health Officer of Health Coda, and co-founder of RS Partners, a health IT consulting and investing firm.

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Flagging this for the HIEs in case you haven't made it to page 677 yet (about 10 pages on HIEs, too much to quote/screengrab): https://www.cms.gov/files/document/cms-1734-p-pdf.pdf

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Value-Based Reimbursement Can Decrease Spending on Medicare During COVID-19 https://blog.petrieflom.law.harvard.edu/2020/08/03/medicare-reimbursement-reform-covid19/ via @petrieflom

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