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Disease Prevention is Sexy

Posted on February 22, 2013 · in Health > The Global Is Local

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Preventative health care is sexy. This is true in politics — as a means of addressing our long-term cost issues — but also to providers and patient advocates in terms of quality. We have heard a lot about preventative care in the last few years, especially with the discussion and passage of the PPACA (the Patient Protection and Affordable Care Act), a.k.a. “Obamacare.” But some argue that preventative care is just as expensive as the alternative.

So, does preventative care actually save money?

Regardless of whether or not it works, lowering costs by increasing preventative care is far from a new idea. A very brief search yielded this 1977 article touting the cost-effectiveness of preventative care. The theory is straightforward, and I will not belabor you with the details. In brief, however, it goes like this:

Some kinds of health care are expensive, and are often tied to chronic physical or psychological conditions. Treating those conditions early and often — improving habits and monitoring various indicators — rather than late and intensively should lower costs overall, since emergency or acute care in hospitals is very, VERY expensive. Oh, and health care expenditures are going up, in case you hadn’t heard.  (And although Medicare and Medicaid are part of the problem, they are far from the biggest part of the story…)

http://upload.wikimedia.org/wikipedia/commons/9/91/U.S._healthcare_GDP.gif

US Healthcare Spending as a Percent of GDP

That’s the short and sweet version. Feel free to look out there on that world wide web for far more in-depth discussion and articles, or look into one of the many excellent books on the subject. Also, I recommend the blog post by my colleague, , who provides analysis of one of the Affordable Care Act’s major provisions, State Insurance Exchanges.

In some form or another, earlier, preventative interventions are the basis for many of our health reform efforts, both current and past. Usually there is some lip service to quality of care, too, but savings sell. They’re sexy.

So what is the problem? Take care of people before they are sick, save money doing it, pat yourself on the back and call it a day!

The problem is simply that preventative care is ALSO expensive. In addition, if preventative care is successful, it may simply delay future costs. This argument is not new either, as Marcia Angell writes in the Journal of the American Medical Association in 1985: “Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one.” There’s also a fantastic study often cited by health economists by Manning et. al. proving that smokers and drinkers who die early based on their unhealthy behaviors actually are a net gain on the health economy.

Let’s circle back to the original question though: Does preventative care lower costs?

To help me answer this question, I had the pleasure of speaking with Doctor Jay Sanders yesterday. Among many other roles, he is a Professor of Medicine at Johns Hopkins University’s School of Medicine. He was quoted in Tuesday’s Kaiser Health News report on health kiosks in Walmart stores. These unmanned kiosks are self-service booths that allow customers to respond to questions about their health, diet, and family health history.

Dr. Sanders argued that the Preventative Care/Cost Reduction situation has been misrepresented. He pointed out that in the short-to-medium term (1-15 years), increased preventative care will almost certainly not decrease costs and instead probably drive them up. This does NOT mean that preventative care will cost more overall. Long term costs will likely come down, but the specifics are yet to be seen, and the time factor has been left out of the discussion.

To be successful, according to Dr. Sanders, health care needs to get smarter, more targeted, and more present for patients. He cites technological innovations, some of which are being developed and implemented here in our region, as potential game-changers. For instance, Under Armour and Zephyr are making items of clothing with embedded technology to monitor vital signs for athletes and gather other information for their coaches. Soon these items will be affordable consumer products that can be tied to our mobile devices, gathering data for us to share with our doctors about heart rhythms, activity levels, and asthma symptoms, among other metrics.

Finally, Dr. Sanders pointed out, the onus is on us as individual patients to generate better outcomes. Smart phones, apps, and wearable technology should make us more aware, at the least.

I agree with him, and I draw a tenuous parallel with democracy. We deserve the health, or government, that we get. If we want something different, we really ought to be more involved. If the Affordable Care Act is successful, we should not necessarily expect that success to be immediate. Instead, a long view is necessary, a chance to allow the experiment to take place.

As a parting thought, keep in mind that our spending as a country has not exactly yielded great results in the past. Quite frankly, a new approach could hardly make things worse:

Life expectancy vs health spending

 

IMAGE CREDITS,  University of California at Santa Cruz Health Atlas;
Organization for Economic Cooperation and Development


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