Effective Preventive Care Crucial
MICHELE NORRIS, Host:
A central question in the debate over the health care overhaul is how to pay for it. Many politicians, including the president, have said that increasing preventive care will save a lot of money in the long term. But the Congressional Budget Office has consistently said preventive services won't reduce costs.
Commentator Douglas Kamerow is a former assistant surgeon general and preventative medicine specialist. Here's how he sees the debate over money and preventative care.
DOUGLAS KAMEROW: Not only do many politicians believe that prevention reduces health care costs, but so do most Americans. In a recent survey, 77 percent of Americans agreed that prevention will save us money. It's only logical - find a disease early in its course, treat it and you not only prevent illness and suffering, but you also save the money you would've spent treating it later.
Except that usually it's not literally true. Here's the dirty little secret: most prevention doesn't save money any more than treatment saves money. The question to ask is not whether it saves money, but whether your money is buying good value in health.
KAMEROW: There are three kinds of prevention. Primary prevention takes places before you have a disease and actually prevents it. Childhood immunizations, for example, are the favorite kind of primary prevention. A few shots and you don't have to worry about your kids getting measles or mumps.
Also, counseling people about risky behaviors is primary prevention. If I talk to you about tobacco cessation or sexual behavior and you stop smoking or start using condoms as a result, you're preventing a disease.
Secondary prevention is early detection of an existing disease when it's asymptomatic. So, you have a much better chance of curing it. Screening tests are a classic example of secondary prevention. You get a mammogram, find early breast cancer and get treatment that will, we hope, cure it.
Finally, tertiary prevention is optimal treatment of existing chronic diseases so that you don't develop complications. For instance, regular eye and foot exams in patients with diabetes to watch out for retinal problems and foot ulcers.
Now, it turns out that some preventive medicine does actually save money. For example, the cost of vaccinating an entire population against some diseases is actually less than it would've cost to treat those diseases if they developed in some of the people.
But most types of prevention don't literally save money. The reason for this is that you have to screen a lot of women with mammography, for example, in order to find one breast cancer. So, if it doesn't save money, how do we decide what prevention is worth doing? That's where value comes in.
As Dr. Steven Wolf and others argued in a recent paper on this subject, the question of whether prevention saves money and thus can help pay for health care reform misses the point. What does matter, and this matters both for prevention and treatment services, is value - the health benefit per dollar invested.
Preventive services are worth it if they improve health at a relatively low cost. The way we control health care spending is by moving our money from expensive low-value services - both treatment and prevention - to more cost- effective, but not cost-saving, high-value interventions. That means fewer expensive drugs that extend life a week or a month. More proven early interventions that can extend life for years or decades.
Yes, prevention does not save money, but effective preventive care, like effective treatments is a crucial part of a reformed health care system.
NORRIS: Family physician Douglas Kamerow is a former assistant surgeon general.
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