Can Preventive Care Save Money?

Posted by Nolan Miller on Nov 12, 2009

Filed Under (Health Care)

Last week I suggested that the road to improving health may be to keep people basically “in good health” for longer, and that one way to do this might be increased focus on preventive care through early- and late- middle age.  However, it is a stretch to go from “preventive care improves health” to “preventive care reduces the cost of health care.”  And, the latter point is one that more often comes up in the context of health reform.

The logic behind preventive care is straightforward.  By increasing screening you identify diseases at an earlier stage.  And, if diseases are identified before they become serious, they can be treated and/or managed at a lower overall cost than if the diseases are identified only later once they do become serious.

Sounds good.  So, what’s the problem?  The problem is that screening costs money.  And, you will screen many, many people in order to identify a small number who can benefit from early treatment.  Even though screening is relatively cheap, and the benefits for the small number of people are large, the sheer number of screens that must be done to convey this benefit to a small number of people can often make early screening for a population very costly relative to the benefit derived from it.

This leaves several possibilities with regard to preventive care.  One: the preventive measure lowers overall cost.  Two: the preventive measure increases cost, but the medical benefits associated with it justify the increased cost.  Three: the preventive measure increases overall cost without commensurate medical benefits.  There is widespread agreement that we should adopt measures of the first kind and avoid measures of the third kind.  In the frenzy to reduce the overall cost of the health care system, measures of the second kind are often overlooked.  If, compared to how we currently spend medical dollars, a particular treatment (whether it is preventive or not) has a ratio of health benefit to cost that is significantly larger than typical treatments in our current arsenal, then we should do more of the new treatment and less of the current ones.  Although we are understandably reluctant to increase the cost of care, the necessity of improving the quality of our health care implies that we should make changes of this sort whenever we identify them.

Enter a 2008 study entitled “Does Preventive Care Save Mondy? Health Economics and the Presidential Candidates,” by Joshua Cohen, Peter Neumann and Milton Weinstein that appeared in the New England Journal of Medicine that looks at the costs and benefits of preventive care.  The study finds that, in general, blanket statements about how preventive care can reduce cost are not justified.  Taken as a whole, there is a distribution of cost/effectiveness ratios for preventive care that looks a lot like the distribution of treatments for existing conditions.  In other words, preventive care in general is not superior to waiting for conditions to emerge and treating them only then.

While preventive care in general does not appear to be cost-saving, some particular treatments, such as flu vaccinations for toddlers and colonoscopies for men aged 60 – 64 do appear to reduce overall costs.  Other preventive measures, such as screening newborns for certain enzyme deficiencies and high-intensity programs to prevent former smokers from relapsing, have very high cost/effectiveness ratios (i.e., they are the second type of program above) and should probably be encouraged.

So, can preventive care save our health care system?  The short answer is no.  In a letter in response to an inquiry by the House Subcommittee on Health, the Congressional Budget Office argues that, “for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”  A particularly compelling example is the following:

[A] recent study conducted by researchers from the American Diabetes Association, the American Heart Association, and the American Cancer Society estimated the effects of achieving widespread use of several highly recommended preventive measures aimed at cardiovascular disease—such as monitoring blood pressure levels for diabetics and cholesterol levels for individuals at high risk of heart disease and using medications to reduce those levels.4 The researchers found that those steps would substantially reduce the projected number of heart attacks and strokes that occurred but would also increase total spending on medical care because the ultimate savings would offset only about 10 percent of the costs of the preventive services, on average. Of particular note, that study sought to capture both the costs and benefits of providing preventive care over a 30-year period.

So much for the silver bullet.

11 Responses to “Can Preventive Care Save Money?”

  • Julie Valentyn says:

    I agree that preventative care is something we need to look into for areas when if can lower the overall cost of a disease. While this analysis focused on screenings for early detection, I believe it is also important to consider programs that try to prevent disease from an even earlier stage. I wonder, for example, the cost comparisons for treatment to encourage individuals to stop smoking vs. the long term heath care expenses smokers can expect to incur.

  • Jim says:

    I agree with Julie. Preventative care should start at the source of the problem; people’s life choices and diets. Like Julie states, encouraging people to stop smoking or influencing people to eat healthy could be an inexpensive way to decrease healthcare costs in the future. I know there has been mention of taxing “sugar sweetened” drinks, which would increase the price, and hopefully discourage people from consuming them.

  • Lisa V says:

    First things first, employers need to educate their employees about health risks associated with diet, exercise, smoking, etc. The more education one has on the hazards of these things, the more one is aware of how to correct them. Offering incentives and benefits to be healthy, is one way that a company can ensure their employees are taking care of themselves. It is not unheard of for a company to offer discounts on gym memberships, or nutritionists, or even offer an incentive for a smoker to quit. Preventive care boils down to many basic behaviors that can be altered, manipulated, or even changed, with the help of the employer. Additionally, having a mandatory screening once a year can help identify ailments and hopefully help deal with them. Preventive care is necessary in all aspects, and I believe that it is more important to get screened now rather then wait for something to happen and then treating it.

  • Nolan Miller says:

    I agree with the comments that lifestyle changes such as quitting smoking, losing weight, and increasing activity are beneficial. And, they can be cost-effective. For example, a 1999 JAMA study found that implementing a set of smoking cessation guidelines involving primary care physicians counseling patients against smoking with some follow-up interventions cost about $2600 per life year saved. This is a great bargain. Other programs, like those involving expensive tests for rare diseases, may cost far more than that. This is not inconsistent with the broader points of the post, that preventive care, in general, is not a more effective way of spending health care dollars (and probably won’t lower overall costs of the system) and that we should be looking for measures that have a low cost/effectiveness ratio for both preventive care and treatment of conditions once they emerge.

  • Gagan Bhatia says:

    “A stitch in time saves nine”.

    Preventive care is a very good way to reduce the cost of the health care. Having a good diet is very important component of the preventive health care. I don’t fully understand the health care reforms that Obama is proposing and how that would affect the country in the long run, but if one thing he could do to help the country is to propose a tax on the fatty food and provide subsidy on green salads and fruits and vegetables. It seems funny to me that a burger costs $1 -3 and a salad costs $5 at the same shop. The junk food has become a big threat to not only USA but also a lot of other countries. In developing countries is has become trendy to have fast food than to have a healthy food. Daily habit of eating such food is very dangerous for health and causes a lot of problems.

    The strategy: A nationwide program is required needs to be broadcasted of how the hot crispy double cheesed burger can be a potential cause of the heart disease and obesity. In the free market, the customers have the choice to choose their food. Just by giving the calorie content on the back of the wrapper or the napkin that is only used to wipe the cheese from the hands is not that much effective. They should be told what exactly those calories mean to the body.
    I don’t know whether having a public health care option is good or bad for the country, but I believe, a public salad bar option is definitely good where the government is spending a lot of money in opening salad bars with public private partnership and encouraging people to eat more fruits and vegetables and educating them about the health hazards.
    The cost on such program would be high and fast food companies may object to govt’s spending but that would pay in the long run. For example WHO in its study has projected that by 2020 the chronic diseases would be very high and therefore if not successfully prevented and managed, they will become the most expensive problems faced by our health care systems. People with diabetes, for example, generate health care costs that are two to three times those without the condition.
    Strategy:
    • Support a paradigm shift towards integrated, preventive health care. For example: Eastern countries such as China, India have developed a very good art of living and keeping the mind and body healthy. Yoga for example help in maintaining the balance of the 5 elements of nature within the body.
    • Promote financing systems and policies that support prevention in health care
    • Equip patients with needed information, motivation, and skills in prevention and self-management

  • Brienne Filkin says:

    While I agree that preventative care is likely not the “answer” to the current health care challenges, I am hesitant to support a strictly financial cost/benefit analysis when determining what types of preventative care to support. Because the costs outweigh the benefits of screening for colon cancer in men over the age of 50 does not mean insurers should eliminate such types of procedures from coverage. I understand this type of extreme is not being supported, but the social benefits and quality of life benefits definitely need to be taken in to account in this analysis. The opportunity to save a life trumps the added financial burden.

  • Jonathan La Berg says:

    I also agree with Nolan Miller that preventative care is definitely not the “silver bullet” that some in the media would have you believe. However, I like the fact that people are calling to cut health care costs, and preventative medicine can definitely at least be some portion of that. Like Mr. Miller says, it is obvious that some procedures do in fact have high cost/effectiveness ratios, and these procedures must be sought out in research and encouraged to be enacted. However, I also agree with some of commenters above that preventative medicine is also a lifestyle choice. This problem is definitely a two way street, and people must also take responsibility for their own health by living healthier lifestyles.

  • Michelle Miranda says:

    I would have to disagree. I think preventive care can go much farther than anyone thinks. Consider the number of people in this country who die of heart attacks. Cardiac arrest is the number one killer. Many of these people have invasive and extremely expensive surgeries. When all along maybe if the person has just been taking a certain medication and exercising it never would have happened. Multiply this by the number of Americans who suffer from heart attacks I don’t see how this would not help. I agree it is not the SOLUTION but I think it could go a long way.

  • Carolyn Fischl says:

    I agree with Michelle. I don’t think preventative health care is where we should cut the costs. Though preventative health care may not immediately save money, I think it would be a horrible mistake to cut costs there. I feel that there are some long-term costs and side effects associated with cutting the preventative care that haven’t been taken into account. If preventative screenings are no longer covered by insurance and required, the death rates will significantly increase for diseases such as cancer and cardiovascular diseases. Though this would not affect the immediate costs, the long-term affects would greatly impact society and the economy as a whole. The additional loss of these individuals and the social and economic contributions they made will increase the costs. Take my father for example: the doctor discovered prostate cancer through a routine screening. It was caught early enough that the treatment was quick and painless. Had my father not been screened, the chances of him dying from cancer would have been much higher. If my father had died, not only would my family lose his income, which would affect my siblings’ college education and my own, but also, the government would have lost the 6-digit income tax he was paying every year. In addition, it is likely that at least one of my family members would have gone to therapy to cope with the loss of my father. The cost of therapy is much more expensive than a preventative screening. So although the immediate cost of not screening is about equal to the costs of having the preventative screenings, there are additional costs that have not yet been taken into account. When the additional economic losses suffered due to the death of that individual are accounted for, one will find that preventative screenings do in fact save money.

  • Adam Rose says:

    I agree that increasing the practice of preventative health care could ultimately reduce overall health care costs. Although, there still exist instances of doctors and health care professionals performing unnecessary tests and prescribing numerous medicines that mask health issues rather than cure them altogether. Personally, I feel as though some drug treatments are administered with the hope that the symptoms of sickness disappear without knowing exactly what the problem is and being able to address it properly. Extending preventative care efforts cannot be effective without also investigating the other complimenting areas of possible health care cost cutting.

  • Megan says:

    I agree with Carolyn and Michelle that the issue does not lie in cutting costs for preventative care. Rather than spend more money on preventative care we need to focus on awareness. With the increase of new technology, doctors often spend more money and time on over utilizing new technology in testing patients. In class we studied this phenomenon with talking about aspirin, and how prevalent the use of aspirin is in saving people from having heart attacks. Yet we often do not focus on using some simple methods of prevention–we feel better if we have multiple tests and procedures done. We can apply this thinking to that of preventative care. We need to focus on figuring out a happy medium to preventative care and health care in our system. If we could both encourage people to take preventative measures to live healthier lives–yet promote practical usage of these measures–we would be saving our health care system money while utilizing our system to its fullest potential.