Again, the problem is that the term “preventative care” is so broad that it merely confuses the discussion, pooling the good the bad and the ugly all together.
Without question having access to care at the primary care level is associated with decreased cost. Going to your regular doctor (instead of the Emergency department or self-referring to a specialist or even an Urgent care) will usually provide better value for the health care dollar. Is that “preventative care”? Not really but some lump it together.
Many immunization programs are cost-savings an many of the others are best buys per QALY (quality adjusted life year - the standard metric) saved.
If we applied preventative care rationally, for example screening higher risk groups selectively, then we’d save money and produce many additional quality years of life. We don’t.
I just had my annual physical and commented to my doctor that the next one would be under Medicare. I was surprise tod learn that Medicare does not have the same focus on an annual physical that I have followed for my entire life. Also, I think that far too much gets thrown in the “preventive care” bucket for it to make much sense.
If you are talking about relatively low cost testing for things like high blood pressure, cholesterol or blood sugar, the resulting care and drugs are demonstrably cheaper than treating strokes, coronaries or diabetes that often result from no treatment.
On the other hand, high cost CT Scans, MRIs and the like (often profit centers owned by physicians) that can have high false positive rates and lead to high cost treatment (often expensive surgery or drugs) are much less efficient at controlling costs. Watchful waiting is often a better approach.
Yes, the GQ answer is that preventative care does not reduce health care costs overall. More often than not, it increases them.
Therefore, politicians who say that we can revamp the system and compel people to buy health insurance, and that thereby it will cost less, are not telling the truth. We will not make up for the increased cost by preventing disease.
Saving Medicaid and Social Security by killing all the 65-year-olds … I like it … we’re worthless and unproductive glutting ourselves at the public trough and burden the taxpayers far beyond our value.
Until then, get y’all back to work and pay them taxes … I got a boat payment coming up.
So your position is that the fact that a blank check for everything that calls itself “preventative care” would cost more dollars than it saves is reason to not cover those of proven cost savings (leave alone those that are best buys per QALY saved) and that such informs IN ANY WAY as to the potential savings incurred by handling problems at the primary care level (which happens more often with coverage) than in the Emergency department (which is often the venue used by those who have no coverage)?
Warning to those employed at large corporations - you will start to see these “Wellness” programs in the near future becoming part of your health insurance equation. If you complete the requirements of the program, you may get a discount on your health insurance premium. If you fail to meet the Wellness objectives (overweight or a smoker, for example), you do not qualify for the “discount”. A clever way to make the unhealthy pay more for their habits.
I mention these Wellness programs because they usually have an annual preventive doctor visit as one of the requirements.
Now, I think you need to look at “savings” from another perspective - savings to society overall, or, savings to your company and health insurer. Actuarily, I am sure there is a formula somehwhere that can calculate the risk of a population with a lot of overweight smokers compared to a population of primarily healthy people. The healthy ones probably cost less, actuarily. The key point of this is the following, which the OP nailed:
As long as your healthy and inexpensive years are being covered by the insurance market, and your expensive elder years are being covered by someone else (the gov’t), then yes, preventive visits DO save money (for the insurer).
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.
In fact Shodan that response is not an answer to the op. That is a very debatable political position about mandatory insurance that does not follow from the responses given here in any way. snowthx, my company’s “Wellness Program” gives the discount for participation. Period. I’ve never heard of one that voids your discount if you get a bad score. Nor any that require a visit to the employee’s primary or even having one. Cite that both such practices are common, let alone typical, please.
What I’ve experienced is a program that makes little sense for someone who already is under care but which make good sense as a cheap screen for a population without regular care. They can cheaply and easily identify those individuals who might benefit most from targeted screening and interventions. Always included, for example, is diabetes screening, which is clearly a cost-effective preventative care measure. Identifying someone who is obese, at risk of complications from obesity, and motivated to change (which these processes can and sometimes do) can target obesity care services to those they are most likely to help. Identifying hypertension is cheap and easy through these processes.
Here are a couple of articles that discuss tying your health to your health insurance costs (AKA “Incentives”)…
Companies Increase Wellness Incentive Dollars
"A small but growing number of companies are requiring employees to participate in health improvement programs in order to be eligible for medical benefits. The survey found that:
• Biometric testing. In 2011, 5 percent of companies required their workers to complete biometric testing (such as cholesterol screening) or be excluded from coverage. That number was expected to nearly double in 2012 to 9 percent.
• Health risk assessments. Likewise, 7 percent of companies required completion of a health risk assessment in 2011. In 2012, 10 percent of companies will require it.
“Employers are increasingly expecting employees to take steps to improve their health, conditioning even access to health benefits on meeting certain requirements,” said Helen Darling, president and CEO of the Business Group. “This isn’t surprising given how much control employees can have over their own health and how much poor health habits cost employers.”
Can My Company’s Wellness Program Really Ask Me To Do That?
“But here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20 percent based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%.”
My company’s program (which I cannot cite) does required the screening and an annual preventive exam with your doctor. You can choose not to participate, but then you will not get the discount. However, the program does not have a lot of teeth, as the metrics you are required to meet are not difficult, and even if you do not meet the metrics, they do not check on you to make sure you are making progress - you just need to show you are trying (e.g. attending a smoking cessation program). They are not checking progress, yet.
Some of the costs one might expect as a result of more widespread “preventative care” could be reduced, significantly, by having non-physicians take on a greater role (and I say this as a physician).
One example is nurse-performed colonoscopy for colon cancer screening. Cite.Cite.
In other words, one shouldn’t project costs based on current practices. There are ways of providing ‘quality care for less’ (and, at the same time, freeing docs to do what they do better and, frankly, may be more be interested in doing in the first place).
Thank you for providing the cites that prove what you said is untrue.
The claims:
The implication being that both of such are the norm.
Your first cite documents that three out of four companies use incentives to get employees to particpate and that only a very few “require” particpation. Those few that do require participation do not require a good score or the discount disappears.
Your second cite details that
That they
(Unless those over can still get the discount if they go to a nutrition class or go on medication, for example.)
So we have your articles stating that the vast majority of wellness programs do not work the way you claim. We have your claim that they “usually have an annual preventive doctor visit as one of the requirements” supported only by that how you understand your program works but the programming in your cites mentioning nothing of the kind.
Glad that is cleared up.
Shodan I am not debating that (of limited utility) statement. Your going from that statement to a conclusion that those who claim that mandatory insurance saving the system money overall are therefore stating something that is untrue is the debatable political position despite your faux innocent protestations of only responding with a GQ answer.
The op’s point is a reasonably valid one - a significant portion of the health care dollar is spent on end of life care, (often in those with no realistic chance of meaningful recovery) and no matter how long we delay it every life will have an end of life. Delaying that end period does not reduce its costs.
OTOH the op logic fails to some degree as well. The examples given included:
These are items that may indeed extend life but from a cost POV what they also do is help substantially reduce the risk of people becoming high utilizers during their lifetimes and increase the odds of the individuals only utilizing healthcare dollars to large extents during that end of life period.
People who exercise regularly, do not smoke, are not obese, and let’s add in eat a healthy diet with lots of fiber, fruits and vegetables, and who do not have uncontrolled hypertension, are more likely to be able to work and be productive longer. After retirement they are less likely to need frequent and prolonged medical care from complications of diabetes, stroke, heart attacks. They are more likely top be able to live independently longer. Oh they’ll die of something eventually. Cancer may take longer on average to get them but live long enough and you’ll get it. To the degree that smoking causes a quick death from lung cancer it saves the system money … but the obstructive lung disease and emphysema it causes … the decades of follow up scans and care for long term survivors who get it at 50 and still live to 80 … these go on the other side of that ledger.
So those end of life costs may not be much different and they may have a few years more to have wasteful preventative care visits with their docs, but the decades of paying for the care associated with chronic diseases that don’t kill right away are substantially reduced.
The cost question is how much those interventions to promote exercise, decrease smoking, etc. cost and how effective they are. Those interventions may be system changes, not individually focused, and how to tally up. What has been spent decreasing tobacco use? What has been spent on the media and other campaigns that work to improve childhood nutrition, exercise habits, etc.? The rise of obesity as levelled off and started to drop but what is the dollar costs avoided compared to if nothing had been done? I wouldn’t know how to even begin that calculation.
The second of these two sentences might be true, but the first certainly is not. There might be more cases where preventive medicine costs more, but in the cases where it costs less, it costs a truly staggering amount less. Most of the greatest medical advances in history have been in preventive medicine.
Greatest yes, but reducing costs? Basic water sanitation and public health … saved many many lives as a preventative health care measure but most of them were children who without that intervention would have died young costing the medical system virtually nothing at all. The result of that preventative care? They lived full lives using healthcare along the way. Food safety same thing. It is hard to debate that the child who dies suddenly at age 2 costs less than the person who lives to 83.
Improving quality of life and living longer and well is not dollars.
Preventative care for the most expensive cases (the most expensive 1-5% of people, who eat up 20-50% of medical spending) can save money. Among people who end up in the ER constantly (several times a year) who have several poorly managed chronic conditions, increased health spending in the form of more at home care, more nutritional interventions, fewer/no copays, etc. reduces cost. Sometimes drastically.
Preventative care for healthy or mostly healthy people doesn’t seem to save money as others have posted (testing 200 people to find one cancer, etc). However for people with multiple poorly managed chronic conditions it can save money.
Indeed it is. Because improving quality of life and living longer translates to longer and more effective periods of productive economic activity, which translates to earnings, and tax capacity. Dollars.
All those kids who didn’t die of cholera once clean water was laid on? They most grew up. And took jobs. They contributed.
UDS, maybe maybe not. Remeber that most of what we are currently discussing is extending life beyond earnings years and longer into when citizens are receiving benefits, not paying tax dollars or Social Security in. I mean sure for those old days (okat not so old really and still in parts of the world) when the kids would be put to work in the coal mine or the garment factory and still die without ever getting much health care … but now?
Again to the specifics of the op - promoting exercise as preventative medicine and, for that matter as lower cost treatment. Exercise is potent medicine and if utilized widely more could keep many people off of a lot of chronic meds saving lots of money in the process.
Terr’s first link did answer the op’s specifics about the items asked about, including exercise as above, just not the part selectively quoted … this part:
Back before modern preventive medicine, you had things like plagues that kill off a third of the population of a country. Now, it’s not exactly cut and dried how you assess the economic cost of such a mass die-off, but it’s quite safe to say that it’s huge.