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What if prevention doesn’t save money?
Interesting piece by Ezra Klein today.
The idea that preventive health care saves money is among the most ubiquitous and bipartisan health policy ideas out there. It’s an idea that numerous contenders for president in 2008, Democrat and Republican, endorsed. Prevention, President Obama has argued before Congress, “makes sense, it saves money, and it saves lives.” A recent poll found 77 percent of Americans believe that prevention saves money, with 56 percent believing so strongly.
...
Only 20 percent of those regularly used preventive measures are “cost saving,” reducing costs while improving the quality of health, the research found. The rest tend to buy improved health care but do so at a cost. The chart below maps out how much we need to invest in preventive care to gain one additional quality-adjusted life year, or QALY, a standard public health measure that captures both improved longevity as well as higher quality of life:
?uuid=l-Ns5iQbEeG6UZmisn9jBQ
...
How can this be? The idea that prevention saves money feels intuitive. “When we think of prevention, we tend to think of the individual who benefited,” Russell writes. We conjure up an image of the woman who caught breast cancer early, averting expensive treatments, or the man who brought his weight down and lived a long, healthy life. That, however, discounts all the mammograms that didn’t detect cancer and didn’t prevent anything and all the individuals for whom weight management programs didn’t work. All those costs add up to the point that most preventive interventions cost more than they save.
Does that mean we necessarily invest in every preventive measure that takes a step towards improving health? I’m inclined to say no. Just like every treatment, preventive interventions come with their own set of risks. There’s the risk of the diagnostic test itself — increased radiation, for example, from various scans — and the possibility of an erroneous diagnosis. Some interventions, such as intensive weight loss or smoking cessation programs, also require a significant time commitment, time that presumably would be otherwise spent working, at leisure or with another pursuit. With the risks and burdens associated with prevention, it’s at least worth exploring what we gain from various interventions — how much life, as Obama puts it, gets saved.
...
Only 20 percent of those regularly used preventive measures are “cost saving,” reducing costs while improving the quality of health, the research found. The rest tend to buy improved health care but do so at a cost. The chart below maps out how much we need to invest in preventive care to gain one additional quality-adjusted life year, or QALY, a standard public health measure that captures both improved longevity as well as higher quality of life:
?uuid=l-Ns5iQbEeG6UZmisn9jBQ
...
How can this be? The idea that prevention saves money feels intuitive. “When we think of prevention, we tend to think of the individual who benefited,” Russell writes. We conjure up an image of the woman who caught breast cancer early, averting expensive treatments, or the man who brought his weight down and lived a long, healthy life. That, however, discounts all the mammograms that didn’t detect cancer and didn’t prevent anything and all the individuals for whom weight management programs didn’t work. All those costs add up to the point that most preventive interventions cost more than they save.
Does that mean we necessarily invest in every preventive measure that takes a step towards improving health? I’m inclined to say no. Just like every treatment, preventive interventions come with their own set of risks. There’s the risk of the diagnostic test itself — increased radiation, for example, from various scans — and the possibility of an erroneous diagnosis. Some interventions, such as intensive weight loss or smoking cessation programs, also require a significant time commitment, time that presumably would be otherwise spent working, at leisure or with another pursuit. With the risks and burdens associated with prevention, it’s at least worth exploring what we gain from various interventions — how much life, as Obama puts it, gets saved.
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