Public Health

Financial Benefits From Prevention Are Elusive

Now more than ever people are arguing about the cost and payback on investments for prevention.

is an apple a day worth the cost? i i

Is an apple a day cost-effective? iStockphoto.com hide caption

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is an apple a day worth the cost?

Is an apple a day cost-effective?

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As the green-eye-shade-wearing Douglas Elmendorf, director of the Congressional Budget Office wrote last month:

Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.

So the idea that lots of prevention is somehow going to save, rather than cost money, under a health overhaul looks all wet.

Well, a paper just published online by the wonky journal Health Affairs suggests that looking at the costs and benefits of prevention over a really long time, say 25 years, might give a fuller picture than the 10-year period that's traditionally used in calculations for government budgeting.

Prevention is no financial cure-all, even when assessed over the long haul. But there can be savings for some people some of the time.

When it comes to complications from type 2 diabetes, a national prevention program costing about a $1,000 a year and lasting 25 years would save a little money for patients who enroll when they're young—age 24 to 30, according to the Health Affairs analysis. For the thirtysomethings, the program would break even. And for older people, it would cost more than it would save. The analysis was funded by the National Changing Diabetes Program, an initiative of Novo Nordisk, which makes drugs to treat diabetes.

Just because prevention isn't a money-saver doesn't mean it's not worth doing. As Princeton health economist Uwe Reinhardt told Fortune last year, "Prevention gives you a better quality of life."

Or, as a piece published in the New England Journal of Medicine during the presidential campaign put it last year, careful analysis could figure out which preventive measures give good bang for the buck, even if they don't save money.

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