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

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

"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."
REUTERS/Jim Young

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.

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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.

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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.