Through the health care reform debate we heard a lot about the need for more preventive medicine and the argument that preventive medicine saves money. A recent report demonstrates that preventive medicine only saves money when the right people utilize it and the right preventive measures are utilized.
Almost 75% of healthcare spending in the United States is for largely preventable chronic illnesses such as Type 2 diabetes and heart disease so in theory more preventive care should cut costs.
Disease prevention programs like immunizations do save money – over time. Immunizations are relatively cheap and large segments of the population are vulnerable to the diseases the immunizations help to prevent. The cost of providing the immunizations to everyone is less than that of treating the illnesses they prevent.
Counseling adults about using baby aspirin to prevent cardiovascular disease produces savings. Aspirin is cheap and the cost of heart disease, which strikes one in three US adults, is enormous. Screening pregnant women for HIV produces net savings as well.
These, unfortunately, are exceptions.
From a pure cost perspective preventive care must be given to large numbers of people to get results. That’s why immunizations are effective. Everyone is at risk for the disease the immunization is intended to prevent. Many preventive services are going to need to be provided to a large number of people to prevent one, single, expensive illness and that is why many popular cancer screenings are falling out of favor.
You would think that if you provide care to prevent a bunch of expensive diseases that health are spending would decrease. The problem is prevention itself costs money and some preventive measures can be very expensive and since not everyone receiving the preventive measure will actually end up with the disease you end up providing preventive services to a lot people who don’t benefit. It’s like treating every house in the US for termites. The vast majority of houses would never have been infested in the first place so the money spent to avoid the infestation is money spent for no benefit.
For preventive medicine to save money there must be a gauge on bang for the buck. There is also an ethical aspect that must be considered. Preventive medicine should not only be measured by cost savings but also health value, the preventive care should buy more health than treating the disease costs.
For preventive medicine to have big bang for the buck a low-cost, high reward approach could be beneficial and the easiest is exercise. There’s no question that exercise and physical activity prevent disease and increase health. Community based activities and easy access to exercise areas and equipment would be an easy way to invest a little but get a lot of return.
The other approach that needs to be considered is targeting preventive care at those most likely to develop a chronic disease and not at low risk people. This type of “smart” prevention increases the chance of preventing expensive diseases and saving money. It will, undoubtedly, cause some disease to missed somewhere along the way but it does provide more bang for the buck.
Preventive care is important but we shouldn’t overlook the value of targeted prevention and the value of low-cost prevention such as exercise. I am in no way suggesting that preventive care measures should decrease – I am suggesting that the approach should be re-examined…