I’ll put it in GQ in case there is an obvious answer, but a debate may break out.
It was mentioned in the other thread, but I didn’t want to hijack it, so here we go. I fully admit that my knowledge of medicine is poor at best, but expending public funds to promote exercise, eliminate smoking, obesity, no rum for breakfast, etc. would seem to reduce health care costs, but I don’t see how it would.
Instead of people dying in their forties, fifties, and sixties from poor lifestyles, we all adopt healthy lifestyles and live into our nineties when we get cancer, heart disease, diabetes, etc. The costs of health care remain the same, it’s just deferred to later years. Social security payments for the population times ten years is enormous. Further, even with a healthy lifestyle, dementia may set in causing an increase in long term care expenses. Also, if I die at age seventy instead of sixty, Medicare pays for my end of life expenses instead of my private insurance.
Have there been studies that prove the cost “savings” of preventative medicine? Why is my first instinct incorrect?
Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. 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.
One big reason why preventive care does not save money, say health economists, is that some of the best-known forms don’t actually improve someone’s health.
These low- or no-benefit measures include annual physicals for healthy adults. A 2012 analysis of 14 large studies found they do not lower the risk of serious illness or premature death. But about one-third of U.S. adults get them, said Dr. Ateev Mehrota, a primary-care physician and healthcare analyst at RAND, for a cost of about $8 billion a year.
…
The second reason preventive care brings so few cost savings is the large number of people who need to receive a particular preventive service in order to avert a single expensive illness.
…
For instance, 217 high-risk smokers would have to undergo a CT lung scan for one to be spared death from lung cancer, according to a database of studies maintained by Dr. David Newman, an emergency physician at Mount Sinai School of Medicine in New York City. One hundred post-menopausal women who have had a bone fracture would have to take drugs called bisphosphonates in order for one to avoid a hip fracture.
Over the past four decades, hundreds of studies have shown that prevention usually adds to medical spending. [Data] from 599 studies published between 2000 and 2005 [show that] less than 20 percent of the preventive options (and a similar percentage for treatment) fall in the cost-saving category—80 percent add more to medical costs than they save.
Dr. Russell’s finding bears repeating: hundreds of studies showed that 80 percent of preventive services added more to medical costs than they saved.
Another factor is the cost of false positives. As the recent studies of tests for breast cancer show, if a large number of tests suggesting something is happening lead to expensive subsequent tests which turn out to be useless, then preventions costs. This is especially true if the true detection rate is very low.
I’d be interested in seeing an analysis of the benefits of early intervention, that is, availability of a doctor once some minor symptom is detected which might indicate bigger problems later.
The obvious way to reduce health care costs is to not spend any money on health care at all. Thus the OP’s question is not very useful.
The useful question is which things have the most bang for the buck–for example which things have the lowest cost per adding a year of life–and here preventive activities rank highly.
“Preventative Medical Care” is so big a brushstroke as to be meaningless. Some clearly are cost-savings. Some are merely good values getting more quality years of life per dollar spent than many treatments do. Some are money poorly spent.
In general though, yes, getting people to die fairly young - right near the end of their economically productive years - is what makes the most economic sense. From the economic POV you want people to smoke because smoking will kill them before the use up much in the way of resources.
I see the OP’s question as highly useful, just not very advantageous for the politicians who have misled us about savings from expanded preventative care.
I don’t doubt that some kinds of preventative care will save money in the long run. Others will add considerably to health care costs.
Example: There are multiple initiatives going on in my community for long time smokers to get screening chest CTs to pick up early lung cancers. For every small cancer that’s detected early, it should be possible to have less radical surgery and spend less over time for drugs and followup. The problem is that there are lots of small suspicious lung lesions that will require additional imaging (MRIs, PET scans) and biopsies before diagnoses can be made.* A ton of money will be spent reassuring these people that what they have isn’t lung cancer but instead old granulomas from healed infections, inflammatory or fibrotic foci etc.
What preventative care is often good at is saving lives or adding to longevity or quality of life. Those who present it as a big cost-saver are poorly informed or are being deliberately misleading.
*from (my) financial perspective being a pathologist, this is added income. However it’s not so good from the standpoint of rising health insurance premiums (money that comes out of my and your pockets).
How many of those 1/3 of US adults are healthy? This paragraph is consistent with only unhealthy adults (appropriately) getting annual physicals.
It implies that the whole $8 billion is wasted, but some of it may well correspond to adults with a medical condition who do in fact benefit from annual physicals.
Another factor to be considered in the current health care mess is that when you have people who haven’t had covered for years and years suddenly acquiring insurance you WILL see an uptake in costs.
Here’s how it plays out. Of those people who haven’t seen a doctor for a long time a portion of them will get a check up, so that increases costs because without coverage none of those physicals will have occurred.
Some of those physicals will uncover chronic or acute conditions that have not been treated. More costs for treating those.
And some will find something extremely serious that will incur substantial costs to treat.
Most of that, if not all of that, would not have been done without health coverage so yes, all of that will increase costs.
First, whether preventative healthcare measures save money or not must surely depend on the measure. I struggle to believe that polio vaccination, for instance, does not save money over the cost of not vaccinating, and treating polio cases instead.
Secondly, we can’t ignore the indirect financial benefits of preventative healthcare. To the extent that preventative healthcare means that you don’t get condition A, but instead live to get condition B, which costs just as much to treat, we still have to recognise that the measure concerned may have kept you alive, and active, for longer than you otherwise would have been, so we have a larger population working, and paying taxes and social security contributions. So the healthcare costs may not have changed greatly, but they are still more affordable.
And the third of my two thoughts: we have to remember that there are substantial non-financial benefits to staying healthier longer, both to the individuals concerned and to the community. Even if healthcare costs go up and this is not offset by an increased tax and social security take, as a community we may still be getting a better return on our healthcare expenditure. Ultimately what we are buying with healthcare expenditure is health, not lower taxes.
The primary reason for such programs is improvement in quality of life, not cost-cutting. They may have to sell it as a cost-reducer to get it passed by the federal government/local governments, but that’s not why those programs are important.
Besides, in the time between you would have gotten condition A and the time you get condition B, you could park the money you would have spent on condition A in a low-risk money market account, and have money left over when you get condition B. The net present value of your health care expenditures is less.
There is no GQ answer, of course. Some preventative care saves money overall. Some does not. Efforts to promote preventative care will or will not save money depending on the proportion of each of the above categories affected.
I don’t think there’s a definitive way to answer this. The best we can do is look at other similar societies that provide preventative care to all of their citizens. Those societies *are *spending less than we are on healthcare, true. It would be a mistake to say it’s all because of preventative care, though (not that that prevents people from saying it, of course). There are a lot of confounding factors that do not come into play anywhere else, like the fact that we have to deal with insurance companies’ administrative overhead and competition. Other countries take care of it through taxes and their government, and there is much less competition.
Actually the obsession with preventive care is a lot less in some systems that spend less money than we do. Some of the people I’ve talked to in the UK are amazed at the number of physicals and cancer screenings Americans get,
That’s why my company (also my insurance carrier) pisses me off so hugely when they bloviate about how they’re going to pass costs on to the end-consumer (via a high deductible) so we’ll be more conscious of our health because we’ll have to pay more. They then turn around and give us some minor incentives for getting physicals, etc…
The sheer bullshit part of it all is that based on the ages of most of the people who work here and the relatively high turnover, the likelihood of any health problems coming home to roost while the workers are employed here is really low. And most of the costs are likely acute things like children’s doctor visits, sports injuries, colds, allergies, flu, etc… not huge chronic things like cancer, heart disease and diabetes. Most of our costs in my family are due to my 2 year old being a rambunctious boy and the corresponding bumps, bruises, and assorted illnesses that come with being a 2 year old.
So they’re effectively pushing costs off onto us, which I don’t really like because they didn’t drop premiums any but understand, but what makes it the worst is that they coat it with a thick layer of bullshit-flavored chocolate when they go on about how they’re making us aware of our own health and stupid shit like that. It’s the BS that’s infuriating, not the actual costs.
This points to the two kinds of preventative care. Increased cancer screening for people not in the high risk groups does not save money. Increased money spent on helping people manage their diabetes does save money.