Disease prevention often costs more than it saves
Disease prevention often costs more than it saves
CHICAGO – When it comes to health care spending, an ounce of prevention is seldom worth a pound of cure. Take Mrs. Jones, a hypothetical 55-year-old obese woman at risk for diabetes. It costs $900 a year to hire a personal lifestyle coach to help her lose weight and prevent diabetes. Suppose that the coaching works for Mrs. Jones, and she is spared diabetes and all the resulting health bills.
But research shows that for every person like Mrs. Jones, six other people just like her get nothing out of such a program. They either don't lose weight or get diabetes anyway or wouldn't have developed it in the first place. The yearly cost of the prevention program for those six people: $5,400.
That's probably more than Mrs. Jones' health bills from diabetes would have amounted to.
There goes your pound of cure.
The truth is, shockingly few prevention efforts actually save the health care system money overall, despite claims by the president and some in Congress.
Discussing daily aspirin use with people at risk of heart disease does save money. So do vaccinations for children. When doctors talk to smokers and offer medication to help them quit, that, too, saves money.
But those are the exceptions.
Prevention is a good deal, some experts say, if you can buy one year of perfect health for less than $50,000. The most-recommended prevention efforts — like flu shots for adults, Pap smears for women and colon cancer screening for people over 50 — meet that cutoff. But they certainly don't save money.
Some say cost is beside the point, since those things save lives at what's deemed a reasonable expense.
Back to Mrs. Jones. Helping 100 people like her would cost $270,000 over three years, but also would prevent 15 new cases of diabetes, avoid the need for blood pressure or cholesterol-lowering pills in 11 people, avoid $65,500 in medical spending for all 100 people and prevent 162 missed days of work due to sickness.
Dr. Ronald Ackermann at Indiana University School of Medicine in Indianapolis said recent studies suggest that offering the diabetes prevention program to groups of 10 people — instead of one-on-one coaching — can lead to similar benefits and cost as little as $15 per month.
The YMCA is offering just such a group program. Retired accountant Paul Mullen, 66, of Indianapolis, has lost 18 pounds since May and brought his blood sugar down because of lifestyle changes he learned. He pays $115 for the yearlong program, on top of his Y membership fee.
He feels better, his knees don't hurt as much and he can't wait to see his doctor's reaction when he gets his next checkup.
"I should have done it years ago," he said. "My daughter-in-law got after me. The wife did, too. So far, it's worked."
Michael Maciosek of HealthPartners Research Foundation in Minneapolis found that of 25 highly recommended prevention strategies, 15 cost less than $35,000 for every year of perfect health gained.
Those are definitely bargains if you're using the arbitrary cutoff of $50,000 per healthy year to decide what's a good investment in health spending. And some economists say Americans would be willing to spend even more than that, say $100,000 per perfect health year.
No one really knows how much of the U.S. health care dollar goes toward prevention. The most commonly cited number — 3 cents of every health care dollar — is based on 20-year-old data.
An updated number — nearly 9 cents of every health care dollar — represents about $194 billion, said George Miller, who led the research for the Altarum Institute, a nonprofit consulting group.
Legislation pushed by Senate Democrats mentions "prevention" repeatedly. The Senate panel heading up health reform also calls for more research on prevention, creates a new interagency council to coordinate a national health promotion strategy and permits insurers to give incentives for health promotion and disease prevention.
President Barack Obama as recently as April said investing in prevention "will save huge amounts of money in the long term." And it has become almost an article of faith among Republicans, Democrats and business leaders that prevention reduces health care costs.
But the Congressional Budget Office last week issued a statement on health care overhaul that dismissed the notion that prevention saves money. Prevention "would have clearer positive effects on health than on the federal budget," the CBO said.
The Partnership to Fight Chronic Disease wants the budget office to be more generous with its review of prevention, to take a longer time frame and to calculate savings to the private sector in lower absenteeism and higher productivity.
But researcher Peter Neumann of Tufts Medical Center said counting on disease prevention to save money "promises painless solutions to our health cost problems. I don't think they're going to be painless and they have to be done."
Supporters say each prevention effort should be held to the same standards as surgical techniques, drugs and medical devices, and not be expected to save dollars: Does it work and at a reasonable cost?
Prevention efforts with high value, although not cost-saving, include flu and pneumococcal shots for adults, Pap smears to screen for cervical cancer, colon cancer screening for people 50 and older, and screenings for vision problems, high blood pressure, high cholesterol and problem drinking.
Each of those things costs less than $35,000 per year of perfect health.
Those strategies are a good place to start when money is limited, experts say.
"Some preventive services save money and some don't. Many of the services that don't save money improve people's lives at relatively low cost," said Robert Gould, president of the nonprofit Partnership for Prevention. "I think that's what the American public wants from health reform."
http://news.yahoo.com/s/ap/20090624/ap_on_he_me/med_health_prevention_reality_check/print
Here's what these "health experts" did not think about.
What if they give people the wrong advice?
What if they told people the wrong thing and all that work achieved little to no response?
Is all that time, effort and cost worth it?
No - because it was their poor advice that caused no improvement.
What if these patients received great advice and lost most of their fat, got off all their prescription drugs, cured most (if not all) of their health problems, did not have to go to the doctor for visits and tests any more, never were sick, did not have to buy all the over the counter medicines, had twice as much energy to get twice as much each and every day.
How much would all that be worth?
How much $$$ would that save?
Don't tell me that it can't be done. Because millions of people - just like me - did that exact thing.
We're saving all kinds of time and money and enjoying life like never before.
All because we did not listen to the advice from the "health experts".
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Keith, Millions of people is probably overstating unfortunately. Very few seem to be able to eliminate bad carbs for life. People seem to be obsessed with so called "healthy" substitutes for sugar, pizza, desserts etc.
There is no substitution, only virtual elimination of sugars and grains. Does anybody know of statistics on long term adherence to to paleo/primal lifestyles?
I do not have personal face to face contact with any other person following paleo. Here in the UK I would guestimate there are probably alot less than a 500 thousand true, long term followers. Less than 1% of the population.
I may be wrong but strip out the faddies and there ain't that many.
On the up side, we are a growing minority.
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Bill:
First thank you for your well thought out comments.
Low carb research and books have gone back like 150 years. I would bet that millions of people have tried the Atkins diet alone - not to mention all the other millions that followed some other low carb and low glycemic diets that have been out there over the years.
I agree that a lot of people do not stick with healthy living and lifestyle.
But what would happen if the governments, Medical Associations, Diabetes Associations, nutritionalists, and all "health experts" told the same direct, clear, explicit message - about the dangers of eating high glycemic foods - like they do for alcoholism, smoking cigarettes, and drugs?
I don't know about the UK - but here in the US - "health experts" teach the opposite - that high glycemic foods are what make you healthy! And then they wonder why the kids are so fat, lazy, have discipline problems, have so many health problems that only senior citizens use to have, and can't focus and pay attention in class!
The stupidity is incredible.
Unfortunately - most people do not start changing their ways until after a trip to the emergency room.
Research of smokers, drug users, and alcoholics shows that about 20% can not stop. They try and try to stop but never are successful long term.
I agree that the drop out rate for low carb/glycemic eaters is probably higher - but what if the general population got a clear message from all "health experts" that high glycemic foods kill? Don't you think it would bring the long term retention rate up to 80%?
I think that the eating of high glycemic foods is very much like the addictions of smoking, alcoholism, and illegal drugs. I think that it should be treated the same.
BTW I eat something similar to the Paleo diet - mostly meat, cheese, and eggs. I think it is wonderful for men.
Women - probably more like the mediterranean diet with more low glycemic veggies and healthy plant oils.
Best of luck to you! Keep up the good fight!
Keith
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Keith said "Research of smokers, drug users, and alcoholics shows that about 20% can not stop. They try and try to stop but never are successful long term."
That means that there are 80% that can stop, but don't!
I am an anarchist regarding governments and health. You and I KNOW that the majority of guidelines are wrong. But the masses follow and believe the lies and always will.
The majority of adults wear steadily growing fat suits. Even the skinnies will have internal visceral fat. It's just the way it is.
To me, it's all down to minimising inflammation in the body as the main goal.
Great blog, by the way. Keep the topics coming....
Bill.
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Quite an impressive observation Carla. Sometimes it happens that we waste a large sum of money on insurance and other medical preventions, and on one day we think, that it would have been better to spend on its cure than its prevention. But sometimes, prevention results into a better decision for someone like me. Because of having many heart problems, I was enrolled in a concierge Healthcare program. I was attacked by a severe heart attack in a party, luckily surrounded by many people. Some of the sudden changes in my body was recognized by me and anticipated immediately. I got a very severe chest pain which was almost unbearable for more than a minute. I got the suspicion that I might be having heart attack, and immediately called my physician on the phone, and explained my condition and its severity. Because of the immediate guidance, I was directed immediately to have an aspirin which I used to carry with me as prescribed by my physician. It was quite a frightening experience for me to face such a heart attack, but somehow I managed to be calm until 911 arrived. I was immediately taken to the nearest hospital, where already my physician were present and have got everything setup according to my medical history. And it was in some matter of seconds that everything was in control. A doctor, who already have the complete knowledge of the medical history and fitness of the person, extra ordinarily ameliorate your recovery process.
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