It’s all those deep-fried Mars Bars we eat. 
As your link for the latter says:
You mean as opposed to not getting treatment at all?
The healthcare systems of other countries - private and public - are by no means perfect, but you should not let the search for perfection get in the way of adopting something better than the present. You can always improve it later.
Your first article says that some preventative services will save 0.2% of medical spending, and those are just the ones where we come out ahead financially. I’m not denying preventative services could increase health span, disability free lifespan and life expectancy. Even if they cost more, we should do them because quality of life and being free of disability are laudable medical goals. But alone it doesn’t seem like it will do much to make our system more affordable.
Those were figures from 2006, in 2014 it would likely be closer to $6 billion. But still, it is a tiny fraction of the 2.8 trillion we spend on medicine.
That seems to reflect a basic misunderstanding of how Canadian health care works, as if it was some monolithic government-run entity. In fact the health care provider system of doctors and hospitals in Canadian provincial health systems looks very much like it does in the US – doctors in private practice, for-profit private clinics, and independent hospitals. The only significant difference is that there are relatively few private for-profit hospitals – most are non-profits run by a board of trustees.
No, it’s data compiled by Medicare. If you look at the total, it equates to all health care spending.
The kinds of conditions in the top 1-5% cohort are things like extremely premature babies, people with multiple cancers, people with End Stage Renal Disease, people with congestive heart failure, and people with severe multiple conditions.
So yeah. They’ll live longer than they would without treatment. I don’t think a humane country would have it another way. I do think we should talk to patients more about how they want to spend their last days/months/years, and adjust treatment to those wishes*. In some cases, money may be saved. Not in others.
(*Dr. Atul Gawande has written a book, “Being Mortal”, on this subject that I plan to read; I haven’t yet because the anniversary of a death is coming up.)
I completely agree.
This is an important part of responsible medical practice. But when Obama proposed funding for it in the ACA, deep thinkers like Sarah Palin and Betsy McCaughey declared that the ACA was setting up government death panels – look out, they’re coming for your grandma!
I haven’t read that one yet, but I’ve read all his other books, most notably Complications: A Surgeon’s Notes on an Imperfect Science, Better: A Surgeon’s Notes on Performance, and The Checklist Manifesto: How to Get Things Right, as well as his New Yorker articles. I’m a great admirer of Gawande and as a physician he’s a credit to the profession.
Places like Israel, Japan, the UK, etc. have extremely sick people who need a lot of medical care and they provide high quality care to them and everyone else for 8% of GDP.
Point is, preventative care may save decent money for the sickest/most expensive 1-5% of people, but for everyone else it is pretty much a wash. We should still do it, but it isn’t a good way to save money.
Saving money requires a totally different approach that probably involves streamlining administration, introducing competition and market forces, utilizing comparative effectiveness, structuring the system to push for the cheapest effective treatment rather than the most expensive, etc.
I think we need to deal with our illegal immigrant problem because many hospitals get overloaded with these illegals showing up in their ER’s needing medical care, and leave without paying a dime. I’ve heard of in some places people even deliberately fly into hospitals like in say Florida and get expensive medical treatments, then just fly home.
Yeah, I’m aware of the cost per capita spent by the US.
Preventative care is a good way to save money in the long term. It can be difficult to get that concept across to my company’s clients.
You make other changes (such as keeping care in network and reducing duplicative tests) to save money short-term; you perform preventative care for long-term savings.
I don’t think anyone in the thread is suggesting otherwise.
Cite?
Any idea what percentage of our healthcare costs that is?
(Hint: it’s not the biggest problem. It’s not even second or third biggest.)
It was my understanding it was a wash, people who get preventative care and have good lifestyles still get sick, develop expensive health problems and die it just takes a few extra years. Does medicare spending for seniors who engage in preventative care and healthy lifestyles end up being less than for people who do not?
I’m trying to find the article but I recently read one saying people who enter their senior years in good health end up costing more over the rest of their lives as people who were unhealthy as they entered their senior years.
That may be true, inasmuch as the unhealthy ones die sooner. But no one would hold that up as an argument against good health care, so I’m not sure that it’s relevant one way or the other in a discussion about the value of preventive care. In the context of the overall subject of this thread, the experience of other countries is that you can achieve immense savings compared to what Americans are paying (ignoring politics and ideology for the moment), and in the process achieve universality as well as affordability.
As GrumpyBunny said, no one here is really arguing otherwise, but I’m not really sure how you believe “competition and market forces” are going to do much to lower costs when, in fact, the existing system is pretty much defined by competition and market forces which it has out the wazoo, and that’s basically what’s driving the cost increases! Like the issue of oversupply I mentioned before, because even if you have glut of competitive providers with expensive equipment and staff sometimes sitting idle, they can still make money!
I’d modify that statement by taking out “competition and market forces” and substituting essentially the opposite: “control of provider costs by a central agency via negotiated fee schedules”. This is a huge, huge cost saver.
Here, for instance, I pulled out some random fees from the OHIP (Ontario) fee schedule. To be clear, this is what single-payer pays the providers, and it’s also the total cost, as there are no co-pays. This is from 2008 so it would have to be adjusted upward for six years of inflation, but to anyone familiar with comparable US costs this ought to cause some jaws to drop!
Family practice – general physician office consultation $56.10
General/family physician ER assessment $76.90
Cardiology consultation – non-emergency hospital in-patient $132.50
MRI - spine - multislice sequence $61.30, $70.50, $104.70 depending on # of segments
MRI - spine - each repeat for another plane $30.70, $35.20, $52.15
Diagnostic ultrasound - pregnancy $50.00 (technical fee) + $31.60 (professional fee) = $81.60
And to anyone who thinks this is so low that it’s amazing that doctors don’t just leave, what’s actually amazing is how much doctors can make when they always get paid in full and don’t have to pay for an office-full of staff whose sole purpose is to chase after insurance companies.
wolfpup makes a good point, which happens to be in line with something I’ve been researching.
THE biggest driver of healthcare costs, bar none, are inpatient (hospital) services. But we still don’t have any basic guideline of what they cost. As a result, reimbursement for care varies wildly between hospitals. I found one example where an inpatient maternity stay at Mass General cost was reimbursed three times higher than an inpatient maternity stay at a regional hospital. Why? Was the care that different?
The Boston Globereports on the same issue with care:
We do not allow large public providers to negotiate for medical goods or pharmaceuticals for one thing. We do not have transparent pricing for consumers of healthcare. I believe medical providers do not publish the prices they charge hospitals and other medical providers. Making all the costs transparent and incentivizing picking the lowest cost should help drive down costs.
“control of provider costs by a central agency via negotiated fee schedules” is what is missing in our system, but that requires transparent pricing, negotiations, comparative effective, etc. All the stuff I was talking about. I don’t believe the onus of pricing should be totally on the consumer, our entire system needs transparent pricing and negotiations.
Ditto. I love when he’s on NPR (he was on one of the Science Friday shows a couple of weeks ago), because he also does a great interview. I wish we had more people thinking about healthcare as an issue about people, not numbers. The data wonks (and I’m one of them) and politicians can forget that sometimes.
I’m wondering, do the people saying that preventative care is clearly economically advantageous for the very ill, not so clearly for the rest, including vaccines and obgyn preventive care (wellness checks, contraceptive methods) under “preventative care”? Because I’d say those are both damn useful and very cost-effective for society in general.
I suppose it depends on how close to end of life someone is.
Someone with a chronic condition or two or three? Yes, vaccines, OB-GYN care, contraceptives, and so on, are all worthwhile and indeed, standards of normal care (for example, flu shots for diabetics, asthmatics, people with heart problems…)
I am operating under the assumption that preventative care means testing and treating for chronic diseases of old age and lifestyle. Public health initiatives to fight microbes, toxins, environmental dangers, etc are a good investment. Most of the life expectancy benefits of the last century were from public health.
My understanding is that if you screen X numbers of people at high risk for a disease or risk factors, a % will have them. Of those people, a % of them will experience benefit from treatment. But a certain percent will also experience a lot of unneeded emotional distress, health damage from treatments, etc.
I think with breast cancer you need to screen 300-2000 high risk people to save one life. Of those 300-2000 most will see no benefit, some will get unnecessary surgery, some people will get negative health effects from the treatments or testing they didn’t need, etc. I don’t know if people come out ahead with it, but I’d doubt it.
Or with aspirin therapy for CVD. That article posted earlier said aspirin therapy is one of the few cost effective treatments for CVD prevention. But doesn’t aspirin therapy only prevent non-fatal heart attacks (not fatal ones), while increasing the risk of injury and/or death from bleeding disorders? That seems like a wash health wise. I don’t know the details, but if a small % aren’t getting non-fatal heart attacks but instead are getting bleeding disorders is that better?
It is like fibrates for heart disease. A study found they slightly decrease risk of death from CVD, but increase it from other things. Meh.
From where did you get that idea?
Are we not allowed to do that, make facts up on the internet? Because I’ve been doing that since the Clinton administration.
I found the study in question looking at 20 preventative care initiatives.
http://www.minnpost.com/sites/default/files/attachments/12-3-10_KCC-Agenda-1%20copy.pdf
Some were for infectious disease, some were diseases of age, some diseases of lifestyle, some were diseases that lowered quality of life. So much more well rounded than my assumption that it was just diseases of old age and lifestyle.
According to that study, childhood vaccinations come out far ahead for savings. A few others save a little bit of money, but not nearly as much as childhood vaccination. Almost everything else costs more money than saves money.
I have no idea how in that study the came to the conclusion that depression screening will save 0.0 life years per 10,000 people screened. Depression knocks years off your life expectancy.
I can’t see the PDF, unfortunately. Windows 8 seems to take random dislikes to some of them for some reason.
Anyway, there are a number of agencies coming up with preventative health initiatives. An example of some of the most common across all age groups is reported in the Boston Globe.
You have to keep in mind that not all measures are appropriate for all populations. Chalmidya testing is really important for young women; it’s less so for a 75-year-old man (or maybe it is sometimes, I’ve heard some interesting stories about canoodling in nursing homes). Osteoperosis is a problem among some populations, not a problem at all among others.
So obviously, some stratification of the population happens to get the group that needs the preventative health measure.