Concept Challenge
Just when you thought there were a few certainties in the healthcare debate! Prevention is a good thing, right? It saves money by keeping patients from needing expensive healthcare. An article in today’s Washington Post challenges this belief under the heading, “Prevention is often more expensive than treatment.” Both Democratic candidates have issued positive statements on the benefit of prevention, but McCain doesn’t see life this way. (Check out an interesting graphic on candidate positions in healthcare.)
How can this be? Like so many things in life, it depends on how you look at it. If you’re a politician trying to minimize healthcare costs for the country, then prevention is not a bargain. The article cites a Dutch study showing that “over a lifetime, healthy people incur the most cost, followed by the obese and then smokers.” The reason, of course, is that healthy people live longer and thus have more time to spend money on healthcare. Smokers die early. Perhaps Medicare should issue free cigarettes to beneficiaries as a cost-cutting move. I once advised our hospital administrator to open a motorcycle store, because it would be good for business. Same thinking. I remember reading (a very long time ago) that it was cheaper to let a few women develop cervical cancer than to do PAP smears on the population. An HMO in Milwaukee tried this approach--just stamped all the PAP smears “normal” without even looking at the slides. A few women died, but the HMO made lots of money.
However, if you’re an individual, you want that PAP smear or mammogram or colonoscopy, even if it does cost the healthcare system money. Another way of looking at the question is to calculate how much it costs for every year of life saved. Then, of course, you have to decide what a year of life is worth to society. Would you spend $1,300 per year on each smoker? How about $160,000 per year for statin therapy? For more on these ideas, look at books by Louise Russell.
Bottom line: before endorsing prevention as a strategy, you have to make some hard decisions. It’s not a magic bullet. Targeting the prevention efforts to those who most need them may improve the financial return.
