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Why preventive-medicine services aren't lowering health-care costs

doctor with patient
REUTERS/Jim Young
"Low- or no-benefit measures include annual physicals for healthy adults. A 2012 analysis of 14 large studies found they do not lower the risk of serious illness or premature death."

In an article published Tuesday by Reuters, health and science reporter Sharon Begley does a great job of debunking the widely held belief that providing more preventive medicine will significantly cut health-care costs.

In fact, notes Begley, a 2010 study [PDF] in the journal Health Affairs “calculated that if 90 percent of the U.S. population used proven preventive services, more than do now, it would save only 0.2 percent of healthcare spending.”

That’s not to say that some preventive services don’t reap savings. Childhood immunizations are one great example. But, as Begley points out, the disease-prevention programs that actually save money are the exceptions. Most don’t. Begley explains why:

One big reason why preventive care does not save money, say health economists, is that some of the best-known forms don't actually improve someone's health.

These low- or no-benefit measures include annual physicals for healthy adults. A 2012 analysis of 14 large studies found they do not lower the risk of serious illness or premature death. But about one-third of U.S. adults get them, said Dr. Ateev Mehrota, a primary-care physician and healthcare analyst at RAND, for a cost of about $8 billion a year.

Similarly, some cancer screenings — including for ovarian cancer and testicular cancer, and for prostate cancer via PSA tests — produce essentially no health benefits, causing the U.S. Preventive Services Task Force to recommend against their routine use. The task force bases its recommendations on medical benefits alone, not costs.

The second reason preventive care brings so few cost savings is the large number of people who need to receive a particular preventive service in order to avert a single expensive illness.

"It seems counterintuitive: If you provide care to prevent all these expensive diseases, it should save money," said Peter Neumann, an expert on health policy and professor of medicine at Tufts University School of Medicine. "But prevention itself costs money, and some preventive measures can be very expensive, especially if you give them to a lot of people who won't benefit."

If preventive care could be provided only to those who are going to get the illness, it would be more cost-effective. "But in the real world, the number needed to screen or to treat in order to prevent one case of illness can be huge," said [Boston University economist Austin] Frakt, who blogs at theincidentaleconomist.com.

Currently, many people who do not benefit from a preventive service receive it, paying something for nothing. Studies have calculated those numbers, which can be surprisingly high.

For instance, 217 high-risk smokers would have to undergo a CT lung scan for one to be spared death from lung cancer, according to a database of studies maintained by Dr. David Newman, an emergency physician at Mount Sinai School of Medicine in New York City. One hundred post-menopausal women who have had a bone fracture would have to take drugs called bisphosphonates in order for one to avoid a hip fracture.

By comparison, only 50 people with heart disease must be treated with aspirin for one to avoid a heart attack or stroke, making this a good buy.

The numbers of people who need to be treated for one to benefit are so high because so few will get the disease the preventive is meant to avert. It's like treating every house for termites, said Neumann, co-author of the Robert Wood Johnson report: The vast majority would never have gotten infested in the first place, so the thousands spent to avoid the infestation is money for nothing.

What we need, reports Begley, are preventive programs that offer more “bang for the buck” — and not necessarily in the doctor’s office.

“Some of the most common chronic, preventable diseases might be best addressed outside the clinical setting,” one expert tells Begley — such as providing easy bus service to parks, where people who don’t own cars can go for physical activity.

It’s an interesting and provocative article. You can read it at Reuters' website.

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Comments (5)

The intractability of the status quo

I have become a broken record on this subject, but it will be very difficult to change current practices in preventive medicine (or anything else in our expensive health care system) because of the huge vested interest in the status quo. Many of the preventive measures outlined in the article may be a waste of money---but every cent of that waste goes into someone's pocket, and those who benefit are going to vigorously fight any change.

I don't mean to imply that these people are acting in bad faith---I'm sure they sincerely believe that the preventive medicine that provides their livelihood is helping people---as it does in some cases---just not enough to justify the cost of universal screening. We're talking about the lab technician's daughter's college tuition, the CT scan operator's mortgage, the office nurse's car payment---not just the doctor's yacht or second home in the south of France. But these vested interests in the current system are a brake on any attempts to figure out what measures aren't worth the cost and to stop doing them.

It's not about saving money

If it was, healthy adult women wouldn't have to have a yearly exam in order to have access to birth control (despite the fact that the American College of Obstetricians and Gynecologists said that BC pills should be over the counter http://health.usnews.com/health-news/news/articles/2012/11/21/obgyns-end...). At least my physician has decided that I don't need a yearly PAP in order to fulfill that requirement. I'm down to every 3 years despite the fact that I have next to no risk of ever getting cervical cancer because I have no risk factors for HPV. Still, insurance companies not only pay for it, but may deny coverage for later illness in the absence of it--even if the illness is unrelated. And companies that make birth control pills are required by regulations to sell only with a prescription. And, hey, as long as a prescription is required, the physician may as well be paid to perform an exam.

Consumer Reports cover story

Just got the latest Consumer Reports in the mail with a cover story on cancer screenings. Bottom line: they recommend only three cancer screening tests--pap smears, colonoscopies, and mammography---albeit much less frequently and for a narrower age range than the current practice. Wait for the backlash in 3,2,1..."what does Consumer Reports know about medicine?", etc. The discussion should be interesting.

Yüz Germe

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Basically people think that

Basically people think that preventive medicine services can lower health care costs but that is not the case always. In many cases the vaccines do not work and after a certain period you are infected with the particular kind of disease. There are also certain diseases like diabetes and cancer that can affect you inspite of precautions. So we must lead a healthy lifestyle and go for regular check ups.

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