Subscribe to the RSS feed.Preventive Medical Care: Does NOT Reduce Health Costs / Does Not Make Us Healthier
As discussions around health care reform continue to dominate the political agenda, it important to understand that “preventive” medical care does virtually nothing to reduce overall costs.
While this may be counter-intuitive for some, the documentation is clear:
As reported on National Public Radio, the Congressional Budget Office has so far “failed to attribute any savings to increased efforts to provide preventive care, challenging the notion that preventive care saves money for the health care system.”
A former Congressional Budget Office analyst said in the report that “preventive services often cost more than they save. In screening people for cancer, for example, he says, ‘you screen literally millions of people, sometimes at fairly high cost per screen. You’ll pick up some true positives, people who really have the disease. You’ll pick up some false positives.’ Then all those people have to be followed up by the medical system, which costs even more money.”
Ken Thorpe of Emory University, one of the nation’s leading experts in medical spending, added that “on the prevention side, at least in the congressional proposals, there is not a coherent, effective prevention strategy really designed to prevent disease in the first place.”
In August 2009, Dr. Otis W. Brawley, chief medical officer for the American Cancer Society, questioned the value of widespread prostate cancer screening, saying “screening does not clearly save lives and many men who get aggressive treatment clearly do not need aggressive treatment,”
Dr. Barnett Kramer, associate director for disease prevention at the National Institutes of Health, has said that “in the field of prevention, few areas save a lot of lives and money. While most childhood immunizations and smoking cessation programs are cost-efficient, the answer is less clear for screenings for breast and cervical cancer,” he said. He added that screening tests such as these can still be worthwhile in saving lives, but they may not save money over the long run.
In a June 19, 2009 article in the Wall Street Journal, Abraham Verghese, M.D., wrote that “prevention strategies can only save money if they deal with behavioral things — eating better, losing weight, exercising more, smoking less, wearing seat belts. But medical prevention strategies — screening, cholesterol checks, EKGs, even mammograms, — these all generate more medical costs.”
Considering cholesterol and mammograms, Verhese said “When someone has a cholesterol test and then is told to take a statin, the chances of preventing a heart attack in that person is still pretty small. Using a statin costs about $150,000 for every single year of life it saves in men, and even more in women.”
To prevent a single stroke, he said, doctors must treat thousands of people who have high blood pressure.
“Reseachers estimate that mammography costs about $100,000 per year of life saved,” he said. “It may be worth it, but it still costs us a lot of money.”
In a December 2007 New York Times column, David Leonhardt wrote that “the current health care system doesn’t pay hospitals, doctors and nurses to keep people healthy; it pays for tests, surgeries and drugs.”
In the same piece, Dr. Mark R. Chassin, a former New York state health commissioner, said that preventive care “reduces costs for the individual who didn’t get sick. But that savings is overwhelmed by the cost of continuously treating everybody else.”
As Jonathan Gruber, an M.I.T. economist who helped design the universal-coverage plan in Massachusetts said “It’s a nice thing to think, and it seems like it should be true, but I don’t know of any evidence that preventive care actually saves money.”
Even the Journal of the American Medical Association said “physical activity as a personal intervention saves money by improving health, but clinical counseling get people to exercise is of uncertain effectiveness.”
So what kinds of prevention strategies do work?
As Dr.Verghese, M.D., wrote, they work when they deal with behavioral factors such as eating better, losing weight, exercising more, smoking less, or wearing seat belts.”
For example:
Nine studies have shown links between smoking bans and fewer heart attacks. Just this past year, a study showed big drops in cardiac admissions in Pueblo, Colorado within three years of its smoking ban.
A study published in a recent issue of the Archives of Pediatrics & Adolescent Medicine suggests that replacing sugar-sweetened beverages with water can trim an average of 235 calories from a child’s daily calorie intake.
Thirty-eight years after President Nixon declared a ‘‘war on cancer,’’ researchers at the National Cancer Institute have concluded that they are falling not primarily because of advances in screening or treatment but instead almost entirely because of declines in smoking.
As Thomas Farley, M.D. has reported, it has also been estimated that a population-wide reduction in sodium intake of 1150 mg per day, which could result from an achievable reduction in the sodium in processed food, would prevent approximately 50% more stroke deaths than successful treatment of every person with hypertension.
Dana P. Goldman, director of health economics at Rand Corporation, has suggested that if a healthier nation is what we want to achieve, we should invest in education and not medical care. We would do better for the nation’s health to take the $120 billion it might cost for universal coverage and use for earlier education and to improve the quality of education at all levels.
“Better educated people live longer, are less likely to be disabled, and engage in healthier behavior,” Goldman wrote in the New York Times. “They also are better at self-managing their chronic disease. And, unlike universal coverage, more education has other valuable benefits to a person and society. Less crime, less divorce and higher earnings — can universal health insurance promise that?”
As Goldman concluded, “it’s time for us to put the priority on health, not health care.”
