CQ TODAY MIDDAY UPDATE
June 29, 2009 – 1:36 p.m.
Is Preventive Care a Cost Saver?
Preventive care saves money, right? Uh, not exactly.
Senate Democrats drafting the big health care overhaul were hoping not only to improve Americans’ health by promoting preventive care but also to squeeze out savings for the government to help provide insurance coverage to people who lack it.
If health care providers can prevent or delay conditions like heart disease and diabetes, the logic goes, the nation won’t have to pay for so many expensive hospital procedures.
The problem, as lawmakers are discovering to their frustration, is that the logic is wrong. Preventive care — at least the sort delivered by doctors — doesn’t save money, experts say. It costs money.
That’s old news to the analysts at the Congressional Budget Office, who have told senators on the Health, Education, Labor and Pensions Committee that it cannot score most preventive-care proposals as saving money.
“I think there’s a great desire to believe that everything that’s good saves money,” says Paul N. Van De Water, a senior fellow at the Center on Budget and Policy Priorities. “Unfortunately, there are a lot of things that are good that cost money.”
The reason preventive care doesn’t save money is simple. To prevent a single stroke, for example, doctors must treat thousands of people who have high blood pressure and therefore are at risk of stroke. The same goes for use of cholesterol-lowering statin drugs, which can prevent heart attacks.
All of those prescription drugs and office visits add up to big money. But many of the patients never would suffer a stroke or heart attack even without treatment. And some will suffer such attacks despite it.
In the end, the expense of the preventive care for thousands of people outweighs the expense of treating the few that would have suffered strokes or heart attacks without treatment.
But while preventive care isn’t cost-effective, Rutgers health economist Louise B. Russell says that doesn’t mean it isn’t worthwhile.
“It’s a good thing to prevent people from getting heart bypass surgery,” she said. “They’re healthier, and that’s what we want the health system to do. But we can’t, unfortunately, say that not only are we going to make people healthier, we’re going to save money.”
Comments
What would be a real cost saver is changing an Agriculture policy that subsidizes five mega-crops which subsidize the fast-food industry, making Big Mac meals more affordable than a produce-rich real meal. With heavy subsidies we grow (1) corn, which feeds beef at a cost of 12 calories in for 1 calorie out, which provides cheap corn fructose syrup that makes sugary soft drinks cheaper than milk or fruit juice. We grow (2) soy, that is used to fry EVERYTHING. We grow (3) wheat, for the buns and (4) oats an (5) cotton. Because of this ag policy, Americans are sicker, fatter, learn worse and ship most foods from agri-businesses average of 1700 miles. If we spent $1 per school lunch and specified that it MUST be spent on produce grown within 100 miles, we would create an immediate market for community gardens, victory gardens and small farms. In inner cities where there are no grocery stores, produce could again become available. The Obama administration has ignored this issue, not wishing to wade into Agriculture politics. Once again, principle buckles to pragmatism. I refuse to talk about healthcare WITHOUT BRINGING UP THIS ISSUE.
Seriously? Am I missing something here, because I really hope this article is satire. To say that preventative care is in the long term more expensive is like saying getting a car tune-up is a waste of money. If waiting until your car dies to fix it seems like a cost-saving maneuver, then I'm guessing you've never had to put that theory to the test. In turn, I sure hope you don't have this same philosophy about your body. Analogies aside, you're overlooking the fact that with preventative care people will get sick LESS OFTEN, and the costly procedures thus required will be administered less often. Besides, shouldn't we be treating all people with red-flag health issues (e.g. high blood pressure) already? Waiting until "they" get sick (in order to cut costs) seems like a good idea until "you" are one of those people. And even if... again, EVEN IF preventative care did cost more, it's still worth the cost of extending human life and general health (including yours!). The strangest thing about this article is that it has the "I'm just sayin" mentality; it doesn't come straight out and say preventative care is a waste of money, but it so heavily implies this that any reader can easily connect the dots. Again, maybe I've misread this and it's all meant as one big laugh. But if it isn't, well, you can't be serious!
As a physician I can absolutely tell you that preventative care doesn't save money- it saves lives. But, not as many as most people assume. Take mammograms for example. A recent study found that a woman at age 45 has a 0.38% chance of dying from breast cancer in the next 15 years. If she regularly gets mammograms during those 15 years the rate drops to 0.28%. In relative terms that means that mammography reduces the death rate from breast cancer for women between age 45-60 by 26% (.28 is 74% of .38), but in absolute terms it reduces the death rate by 0.1% (.38-.28= 0.1). In other words, mammographys saves about 1 woman's life for every 1000 women who get regular screening for 15 years. In addition, approximately 25% of those women will have at least one false postive result during those 15 years requiring further testing and biopsies. Taking all that into account reseachers estimate that mammography costs about $100,000 per year of life saved. It may well be worth it, but it doesn't save money.
In the second last paragraph, the author says, "While preventive care isn't cost-effective..." That's incorrect. Many (but not all) forms of preventive care are cost-effective. Only a few types (mostly vaccines, some corporate wellness programs) are cost-SAVING, meaning that they will produce an actual return on investment. To repeat, many (but not all) forms of preventive care are more cost-effective than intensive medical interventions. We do need to be spending more on the more cost-effective stuff and less on the less cost-effective stuff - not that we should deny lifesaving interventions that aren't very cost effective, though.
Once again we are looking only at a medical model that relies heavily on the pharmaceutical industry. Preventive care should include education of the public - such as the risk factors of HBP and stroke along with means to address this - healthier foods, walking trails, increased funding for physical education in schools, etc. Why do we need to wait for the disease to occur before we address it? Why must we cater to the pharmaceutical industry rather than prevent the need for the medications in the first place. The author is uninformed regarding models of care other than the medical model - such as a nursing model which is more holistic. Nurses provide the majority of education to patients, yet are often sadly forgotten in the process.
This article treats prevention like it's oen product - like a pill. It's not; there are a wide variety of preventive measures. Some of them do, in fact, save money and some of them don't. But even some of the ones that don't save money still deliver more cost-effective health benefits than some medical procedures. Quit trying to separate prevention from health care. We need to find and use the most cost-effective procedures from both areas to really accomplish health reform.
I agree 100% with IsIVoter. As for "You Can't Be Serious," you need to read this article carefully to understand why medical care isn't the same things as tuneups on a car. Then read "The Myth of Prevention," by Veghese in the Wall St. Journal. Then read "Reform Health Not Health Care" by Farley in the American Journal of Public Health. The problem is, we're fed so much BS from the food industry and the medical industrial complex that we believe all the propaganda they spew, and ask if an article like the one above is "satire." YCBS, and other Americans, its time to question what you're fed...
Robin RN, please don't be so passive. Nurses, to their detriment often merely complain about not getting respect, without providing vision. For example, I propose that only nurses and NPs should provide primary care. Screw the family practice docs. They're a financial drag on the system! But no! We're all worried how the docs will react - because they're respective members of society. Hogwash! They've prevented all attempts at national health insurance over the entire 20th century!
To IslVoter: What they hell were you smoking? Your comments aren't intelligible. Between your ranting about hamburgers and wheat, I think you seriously have a screw loose. To YouCan'tBeSerious: You've got a point about the inherent importance and cost-saving of preventative care, which is why I pity you for being surrounded by idiots on this comment list. And sorry dude, they're not only serious, they're serious idiots. (PS. if these guys don't understand that your analogy describes something 'like' the thing but not 'actually' the thing, then they're the uneducated folks, not you. peace). To I'm Serious: Wow, I'd hate for you to be my doctor. If it saves some women from getting breast cancer, then its done its job, and it doesn't matter how many women didn't get breast cancer. If you disagree, then the next time you need preventative care to save your life, don't take it, because clearly you don't think you're worth the expense. To SeriousasaHeartAttack: You are the biggest ignorant idiot of them all. You're pathetic and a classic fool. You criticize others for not being "informed," but the sources you cite are so one-sided and inaccurate that you ultimately come across as the real ignorant fool who has been fed the BS. Oh, what's that? You want my sources? Fine, take a look at the Weiwen Ng, MPH comment, who spells it out quite plainly. Actually, don't bother, just go back to watching your fox news.
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