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An Inconvenient Truth About Prevention

Preventable disease is a terrible burden, made all the more tragic by the fact that it can be avoided.

Policymakers in Washington take this a step further, claiming that we can save huge amounts of money by systematic programs to prevent disease and encourage wellness.  The document explaining the Republicans’ new “Patient Choice Act” says that wellness and disease prevention can save trillions of dollars (.pdf).  President Obama seems to agree, saying these programs like these can create “serious savings” that represent “huge amounts of money in the long term.

There’s one problem:  study after study says it’s not true.

Earlier this year, the prestigious journal Health Affairs published a study on this topic.  The author reviewed the results of nearly 600 studies (abstract at link, full article requires subscription) on the cost-effectiveness of various prevention programs.  The findings are overwhelming – less than 20% of these programs saved money, while more than 80% actually added more to medical costs than they saved.  How can this be?

It isn’t that complicated when you think about it.  Take high blood pressure.  If every American with high blood pressure took blood pressure medication, we would have lower rates of heart disease and stroke, and of course, eliminate the costs associated with those avoided conditions.  But as the study points out:

the accumulated costs of treating hypertension are nonetheless greater than the savings, because many people, not all of whom would ever suffer heart disease or stroke, must take medication for many years.

Studies have shown similar results for other chronic diseases, like diabetes and asthma. There is also important data showing that even screening programs for cervical, breast and colon cancer cost more than they save.

Does this mean we shouldn’t do these things?  Of course not. For each life that is touched by avoiding a chronic disease, finding a tumor early on, staying out of the hospital, there is enormous value.  But the value is not financial. It’s something we do because it’s right, and it’s inherently good.  There are no formulas to measure this.

Health care is very expensive, and the burden of that cost affects us all.  But to talk seriously about this problem we need to confront an inconvenient truth:  there is more to health care than just dollars and cents.

*This blog post was originally published at See First Blog*


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