# Does Preventative Medical Reduce Health Care Costs? **URL:** \ **Category:** Factual Questions\ **Created:** [December 16, 2013, 3:45am UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439 "2013-12-16T03:45:14Z")\ **Posts on this page:** 7\ **Page:** 3
**Author:** ![even\_sven](https://avatars.discourse-cdn.com/v4/letter/e/dfb087/32.png) [@even\_sven](https://boards.straightdope.com/u/even_sven)\ **Post date:** [December 17, 2013, 10:42pm UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439/41 "2013-12-17T22:42:35Z")
The theory behind the OP would only work if the options were: A. Catch something early, treat it, eventually die of old age B. Don’t catch it early, die young. But option B generally isn’t what happens. Rather, people tend to catch something late and nasty, rack up expenses treating it, and then eventually die of old age. Obesity probably won’t kill you directly- but the years of diabetes, knee replacements, and heart surgery will add up before you eventually die. ---
**Author:** ![UDS](https://avatars.discourse-cdn.com/v4/letter/u/ecae2f/32.png) [@UDS](https://boards.straightdope.com/u/UDS)\ **Post date:** [December 18, 2013, 1:21am UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439/42 "2013-12-18T01:21:13Z")
> [@even\_sven](#): > > The theory behind the OP would only work if the options were: > > A. Catch something early, treat it, eventually die of old age > B. Don’t catch it early, die young. > > But option B generally isn’t what happens. Rather, people tend to catch something late and nasty, rack up expenses treating it, and then eventually die of old age. Obesity probably won’t kill you directly- but the years of diabetes, knee replacements, and heart surgery will add up before you eventually die. But you are assuming that preventative health measures can’t reduce the incidence of diabetes, arthritis or heart disease. In fact we know of preventative measures which will reduce the incidence of at least two of these. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 18, 2013, 1:58am UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439/43 "2013-12-18T01:58:16Z")
**UDS** I think that you and **even sven** are not saying anything that conflict. The premise of the op is that you get sick sometime, so what if it is delayed until later? **even sven** is stating that the costs along the way of managing those _preventable_ chronic diseases for many years racks up. (They usually do not kill young at this point. Instead they and their many complications are _treated_ with life expectancy several years but not decades reduced.) Hence the wisdom of investing in preventing them (and the documentation in **Terr** ’s cites that money spent on preventing those things is indeed cost-effective). **Chronos** , meh. Really it is not so quite safe to say. The Black Death was a economic bonanza, at least for the poorest. Wages increased and property became affordable. Population decreased more than resources so the average person had more food availability. On net it is not so clear what the impact was. Seriously the [economic impacts of epidemics](http://www.economist.com/node/1698814) are complicated but not always adverse: > [@](#): > > Perversely, a disease that kills millions of children and old people, for instance, can produce a rise in GDP per head, if those aged 15-45, the most economically productive members of society, are still standing but there are fewer people in total to share the wealth. > > A strange case of flu > > Even when prime earners are killed, economies can recover. The 1918 flu epidemic, which killed 40m worldwide, may be a case in point—at any rate in America, where 675,000 perished. Elizabeth Brainerd, of Williams College, and Mark Siegler, of California State University, Sacramento, have looked at its effects on the growth of income per head in America between 1919 and 1930\*. Surprisingly, they find that (after allowing for other factors) the states with the highest death rates grew fastest. It seems that these states suffered the most immediately after the epidemic—they had the highest business-failure rates between 1919 and 1921—but then caught up. … ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 18, 2013, 2:26am UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439/44 "2013-12-18T02:26:40Z")
There is also a major problem with the way in which **Terr** ’s first cite is interpreted. What is the difference between these two statements? > [@the article](#): > > 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. (Note: “reviewed” in this case being restricted to articles “published between 2000 and 2005.”) > [@Shodan](#): > > Overall, preventative care does not save money. Need some hints? Hint 1: the second is a broad generalization. Hint 2: the sum total of different “preventative measures” reviewed in that five year period in 599 articles were seven. You get the idea. The article is bemoaning ANY broad generalization by looking at a small sample of specific measures studied in a fairly short timeframe. They are explicitly NOT stating anything about what preventative care does “overall.” The second article does make a claim about overall … and overall there would be modest savings. If 90% of the population used advised preventative measures it would save 0.2% of the cost. The [actual article](http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129) that that article references is very interesting and makes a case FOR preventative care, thoughtful intelligent preventative care. Not PSA for prostate cancer but programs like these: > [@](#): > > For instance, at a program in Akron, Ohio, profiled in the new report, physicians and others coordinate care for patients with Type 2 diabetes. It reduced the average cost of care by more than 10 percent, or $3,185 per year, largely by reducing pricey emergency-room visits. > > And at Boston Children’s Hospital, an asthma program that sends community health workers into patients’ homes to reduce the environmental triggers of asthma has saved $1.46 in healthcare costs for every $1 invested. It has reduced asthma-related hospital admissions by 80 percent and asthma-related emergency department visits by 60 percent, reports the Trust. > > The other promising approach is to target preventive care at those most likely to develop a chronic disease, not at low-risk people. Such “smart” prevention increases the chances of preventing expensive diseases and saving money. Another point they make: > [@](#): > > A better gauge of the value of preventive medicine is bang for the buck; that is, not whether it reduces healthcare spending but whether it buys more health than treating the disease does. “We don’t ask whether cancer treatment or heart disease treatment saves money,” said Dr. Steven Woolf, professor of family medicine at Virginia Commonwealth University Medical Center in Richmond. “But it is reasonable to ask how to make our healthcare dollar go further.” ---
**Author:** ![Chief\_Pedant](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@Chief\_Pedant](https://boards.straightdope.com/u/Chief_Pedant)\ **Post date:** [December 18, 2013, 3:40am UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439/45 "2013-12-18T03:40:39Z")
> [@GIGObuster](#): > > Uh, looking at one of the studies where the cites that claim that there are no savings report this: > > [http://www.minnpost.com/sites/default/files/attachments/12-3-10\_KCC-Agenda-1%20copy.pdf](http://www.minnpost.com/sites/default/files/attachments/12-3-10_KCC-Agenda-1%20copy.pdf) > > In essence, one will see benefits for all if we are smart about how and when to use the preventive medicine, those who claim that we are not looking at savings should take into account that if we follow the recommendations of the studies they quote then covering all people does not increase nor reduce costs a lot, meaning that the points that tell us that we should not change the current inefficient system that does not cover all is the real bullshit. > > I have to notice that there was almost no mention of vaccines and efforts to control antibiotics use, besides seeing that the current system regarding those items would be a failure with no government help, I have to say that the studies seem to ignore the cost in lives if the prevention that we get or should get is not maintained. The folks who wrote this article are very confused. They think that if preventative care keeps me healthier, we’ll save money because it’s expensive to take care of me when I’m sick. As I’ve pointed out on this board many times, this is a very incorrect notion. Good preventative care (see the article) might keep my insurers happy because until I reach retirement, they are the ones ponying up when I need healthcare. But then the real costs begin, on two fronts. First of all, I’m going to live longer–maybe a lot longer, sucking off either the public dole or my company pension. Big bucks. Increased lifespan is already killing the original social security calculations when the program was invented. Second, I’m gonna die eventually, and between retirement and death, lots of very expensive things need repair no matter how much preventative care I got. Everything wears out eventually. Plus End of Life care is super expensive, be it some sort of expensive Hospital death or some sort of Nursing Home care, or whatever. The total cost of delivering a healthy person into a 30 year retirement while they get their joints fixed, their coronaries bypassed, their organs replaced and their bottoms cleaned is extraordinary. Economically, we need to get people to smoke like chimneys (paying for smoking-related illness with cigarette taxes) and hope a bunch of 'em drop dead suddenly toward the end of their productive lives right before they retire. The Marlboro men were dream citizens, economically. Preventative care is very very pricey, as is a healthy fresh retiree. ---
**Author:** ![Chief\_Pedant](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@Chief\_Pedant](https://boards.straightdope.com/u/Chief_Pedant)\ **Post date:** [December 18, 2013, 3:55am UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439/46 "2013-12-18T03:55:04Z")
Sample article [here](http://www.medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/06/03/the-cost-and-quality-conundrum-of-american-end-of-life-care) about how expensive it’s getting to die. And (plug your ears here) no amount of preventative care prevents Death…yet. When it does, of course, Social Security is toast from the expense of “preventative care” that worked. Speaking from my own experience as a physician, the healthier a person is when they start to croak, the more we pony up to save them. When I started med school over 30 years ago, we’d have a big debate over whether or not to fix an aortic valve if a patient was in their 80’s. It’s not even a consideration now; the only consideration is whether or not the patient is basically healthy. Medicine is getting fancier. Lots fancier. Within the lifetimes of people retiring now it will be common to replace organs, for example: kidneys; livers; hearts; lungs… Joints when they wear out. Various costly drugs such as anti-aging hormones. Gene therapy… I mean, it’s gonna cost a fortune to die if you’ve had perfect preventative care and so you are healthy enough to basically always meet criteria to fix the one thing that’s gone sour. It just makes me chuckle when I hear this notion that keeping us healthy is going to save us money. Don’t bet on it. Medical costs will not be plummeting Real Soon Now, nor will the cost of keeping healthy retirees (like me, pretty soon) feeding off the public teat. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 19, 2013, 3:23pm UTC](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439/47 "2013-12-19T15:23:14Z")
**CP** your point is very cogent, but not too informative about preventative care overall. Look at it this way … all these people, like you, who may live 25 plus years after you retire, are currently at risk of dementia developing along the way. One in three of you. And caring for those with [dementia is very expensive](http://www.nytimes.com/2013/04/04/health/dementia-care-costs-are-soaring-study-finds.html). If we could get people to keep up with healthy lifestyles we could potentially [cut the frequency of dementia by close to two thirds.](http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0081877). > [@](#): > > Healthy lifestyles based on non-smoking, an acceptable BMI, a high fruit and vegetable intake, regular physical activity, and low/moderate alcohol intake, are associated with reductions in the incidence of certain chronic diseases … the OR for men following four or five healthy behaviours was 0.36 (95% CI: 0.12, 1.09; P for trend \<0.001) for cognitive impairment, and 0.36 (95% CI: 0.07, 1.99; P for trend \<0.02) for dementia. And we, as a society, need to address the huge costs that living longer incurrs. We really should be expected to work longer at this point because we really are able to be productive longer. We need to recognize that in terms of medicine more treatment is not the same as better treatment and that we can provide better value in our care than we do by avoiding the broad generalizations that some want to make. We can work together as teams to provide better care to the populations under our care and that model of care IS emerging. I would put forth to you however that living longer on average is a fait accompli. Now we need to make those years be less costly to the system and of higher quality both at the same time. Intelligent preventative care and effective promotion of healthy lifestyle habits is an integral part of doing that. [Previous page](https://boards.straightdope.com/t/does-preventative-medical-reduce-health-care-costs/676439.md?page=2)