Wednesday, August 15, 2007

Preventive care - a marginal idea?

I've suspected this was true for about 18 years:
NYT Leonhardt - Free Lunch on Health Care ...

... Jay Bhattacharya, a doctor and economist at Stanford’s School of Medicine, estimates that to prevent one new case of diabetes, an antiobesity program must treat five people — “not cheaply,” he says. Along the same lines, Mr. Gruber found that when retirees in California began visiting their doctor less often and filling fewer prescriptions, overall medical spending fell. People did get sick more often, but treating their illnesses was still less costly than widespread basic care — in the form of doctors visits and drugs. Louise Russell, an economist at Rutgers, points out that programs that focus on at-risk patients cost the least, but even they are rarely free.

As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care “reduces costs, yes, for the individual who didn’t get sick.”

“But that savings is overwhelmed by the cost of continuously treating everybody else.”

The actual savings are also not as large as might at first seem. Even if you don’t develop diabetes, your lifetime medical costs won’t drop to zero. You might live longer and better and yet still ultimately run up almost as big a lifetime medical bill, because you’ll eventually have other problems. That would be an undeniably better outcome, but it wouldn’t produce a financial windfall for society.
I don't know if it's an urban legend, but I read over a decade ago that Japan's finance ministry blocked anti-smoking programs because the led to high social security costs. The new addition is that preventive care is not economically efficient because it's not targeted. Presumably, if you could target preventive care more effectively (genomics, patient readiness to change) you'd get more value. Of course if a "pay for performance" program tracks preventive care metrics ...

It's often cheaper to cure than to prevent.

One caveat is that for the informed individual, preventive care makes LOTS of sense. It's only a marginal investment from a societal perspective. Another caveat is that this the research doesn't apply to immunization programs, it was looking at programs that advocate behavioral change.

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