Health Care, Not Sick Care
Does Preventive Medicine Save Money?
It makes sense that preventing disease saves money. Doesn’t it?
After all, if you do not get a disease in the first place, you are not going to have to spend money on health care to treat the disease or any of its complications. Depending on the disease you prevent, you might even live longer.
So why isn’t preventive medicine getting more attention? Why are we focusing more on sick care than preventive care?
What Is Prevention?
Before we can talk about the benefits, we first have to understand what prevention is all about.
Primary prevention prevents a condition from occurring in the first place. You get a flu shot every year to avoid getting the flu. You eat well-balanced meals and you exercise regularly with the intention to maintain a healthy weight.
With secondary prevention, you already have a condition — even if you don’t know it yet. The goal is to detect that condition as early as possible so you can stop it in its tracks or at the very least slow its progression. Colonoscopies, mammograms, and Pap smears all screen for cancer. These tests do not stop you from getting cancer but they can detect it early in its course, giving you the best odds to beat the disease.
Tertiary prevention helps to decrease the impact a long-term condition has on your life. The goal is to decrease complications and impairments from that disease. Cardiac rehabilitation programs can help you to better manage your heart disease and support groups for any number of conditions can offer life strategies to make the best of your situation.
The Impact of Preventive Medicine
We often think of preventive medicine as being for individuals. My mammogram may benefit me, but it is unlikely to benefit anyone else, at least not directly. Preventive medicine can include programs that step outside of the clinic and offer help in a more communal way. Think about all the public health initiatives you have been exposed to in recent years.
The ALS Ice Bucket Challenge raised millions of dollars to research the debilitating disease. The Click It or Ticket campaign increases seatbelt use and saves thousands of lives every year. The Back to Sleep campaign cut sudden infant death syndrome (SIDS) by more than half. The Movember campaign challenges men to grow mustaches every November to raise awareness of prostate and testicular cancer. The Truth campaign warns people about the hazards of smoking.
The question is not whether preventive medicine works. Every life saved is a victory. It is whether we can get the U.S. health system — insurers and government officials (local, state, and federal) — on the same page.
Saving Money with Preventive Medicine
A preventive service costs money up front. With insurers and government officials focused on the almighty dollar, it is often hard for them to look ahead to the potential cost-savings down the road. They do not want to spend the money NOW. They have budget deficits NOW. They want to make a profit NOW.
There are two ways to look at cost when it comes to health care. First, does a preventive service actually save money? In this case, every dollar invested saves more than that dollar cost down the road. Second, if a preventive test does not have high cost-savings, is it at least cost-effective? If a preventive service costs little but has a big impact, it may be worth the money invested. In others words, you get a big bang for your buck.
The problem is you will hear economists argue against secondary prevention, saying tests like colonoscopies are too expensive. Screening everyone would cost a fortune. Not only that, they argue that if these tests increase life expectancy, then those people will cost the health system even more money in the future.
These people obviously miss the point.
Prevention Is About Lives, Not Money
A study in Health Affairs estimates the annual medical cost per person per year for colorectal cancer screening to be $46 but the savings per person per year are $31. Is it worth paying a net $15 a year to screen for colon cancer? Most people would say yes, 100% yes if they were one of the people who is found to have colon cancer.
Other tests will actually save money every year. Childhood vaccinations save $267, pneumococcal vaccination in adults $67, counseling for daily aspirin use $66, advice on quitting smoking $40, and alcohol abuse screening $11 per person per year.
It is important to keep in mind that the goal of prevention is to improve health. It cannot be all about cost, even when you are footing the bill.
When you consider that 1 in 5 deaths are attributable to smoking and high blood pressure and 1 in 10 to being overweight/obese or physically inactive, the impact preventive medicine could have on our health as a nation is undeniable. This is a wellness issue. This is a quality of life issue. This is a public health issue. If we could step forward as a nation to implement preventive measures that could change bad habits, that could help us live healthier lives, we might need less sick care over time.
- Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2011). The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLOS Medicine 8(1): 10.1371/annotation/0ef47acd-9dcc-4296-a897-872d182cde57
- Maciosek MV, Coffield AB, Flottemesch TJ, Edwards NM, Solberg LI. Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost. Health Aff. 2010 Sep;29(9): 10.1377/hlthaff.2008.0701.
- National Prevention Strategy. Surgeon General website. https://www.surgeongeneral.gov/priorities/prevention/strategy/
- Woolf SH. The Price Paid for Not Preventing Diseases. In: Yong PL, Saunders RS, Olsen LA, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Washington (DC): National Academies Press (US); 2010.