Wednesday, March 17, 2010

So, Preventive Medicine Saves Money?

I have been carrying an article with me around the country over the last year or so.  It was written in February 2008 in the New England Journal of Medicine. The "Perspective" asks the question, "Does preventative care save money?"  The writers conclude that most of the political rhetoric about the possible dollars that could be saved by prevention is "overreaching."

The authors make it clear that vaccinations, smoking cessation, low cost screening for a disease (when a cost effective treatment for the disease exists), and avoiding misuse of alcohol DO save money. However, they also point out that expensive high-tech treatments for some diseases might be a more cost effective use of medical care.  I think that the most interesting statement in the article is the following:

  • "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical."  (emphasis added)
I am pretty sure that this finding is counter-intuitive to most of our feelings on the subject.  Somehow, we believe that knowing we have a disease before the effects start to mess with our systems is better for us in the long run (both in terms of health and economics) while the medical research demonstrates that this is not true.  In any case, I thought I would toss this question out for discussion:
  • "Is an ounce of prevention REALLY worth a pound of cure?"
Let me know your opinion.

Whether we like it or not, our future medical care providers (whether private doctors, HMOs, or the federal government) will be looking at some of the issues raised in this short article.  In fact, the "quality-adjusted life-years (QALYs)" discussed in the article are essentially the means by which all socialized medical systems ration care.  I really don't like to think that my health care decisions will be made by someone looking up the QALYs of a particular treatment before deciding to allocate the funds for it.  I like the ability to make that decision myself.  In any case, how much freedom do you think we will have when our heart, lungs, knees, and backs become line items in the federal budget?

Quite frankly, I think a lot of sickness could be prevented if we just stopped talking about a takeover of our health care system by the government.  I know that my blood pressure would be lower if we did.


Josh and Margo said...

I don't know if this comment section is big enough for my response. From what I am getting out of the journal article it seems a little misleading. Can preventive medicine be expensive and add to health care costs...absolutely. And some disease can not be prevented no matter how hard we try. But you can't discount preventive medicine because I believe it does help and save money in the long run....for those things it works for. Another thing I did not see in this article was a study comparing cost of treating a disease compared directly to the preventive treatments of that same disease and the outcomes (and associated costs). I think this article was a little ridiculous. I do think an ounce of prevention is worth a pound of cure....when used reasonably. I also don't understand the fear of the government healthcare and their "death panels". It seems like if it was so bad then not every other country would have it and they would not have better health outcomes than us. Tell me what you think about this info...

Russ said...


First, I didn't mention death panels, but they will exist with a much benign sounding name. Regardless of what you call it, a governmental employee will look at the QALYs (or some other metric) and decide if the treatment will be ALLOWED. At that point, we are not even discussing whether someone could pay for it themselves. Under Hillary Care and Obama Care, the doctor/patient relationship is fundamentally changed in that "pay for service" becomes an ILLEGAL transaction.

In any case, the long run is exactly what the article discusses: Long term costs of testing/prevention versus acute treatment of disease. You are right that SOME preventive medicine can be cost effective, but the article concludes (after looking at 100s of studies) that the vast majority of preventive treatments turn out to be more expensive in the long term.

As far as the cross-country comparison, the Commonwealth Fund is not somewhere I would go to get objective data about medical care. Be that as it may (I love that phrase), the study relies on self reported data. For instance, not every country in the table computes "Infant mortality" statistics in the same manner (basically, the countries treat still births and extreme pre-mature births differently). Also, ask yourself where do people from other countries go for treatment if they can't get access in their own system? For example, the King of Saudi Arabia was being treated at Mayo at the same time we were there, and the Canadian Prime Minister came over to the U.S. for some kind of treatment in the last month.

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