DAVID GREENE, host:
President Obama held a town hall meeting on health care yesterday in Annandale, Virginia. That's just outside the nation's capital. Mr. Obama pushed again for quick action on the sweeping health care overhaul now being considered by Congress, and among the changes he is seeking is a greater emphasis on preventing disease.
President BARACK OBAMA: We need to invest in prevention and wellness that help Americans live longer, healthier lives. We know this saves money.
GREENE: But just how much money prevention can actually save is one of the central questions in the health care debate. When you give people more access to health care, do costs go up because people start getting a lot of expensive care they might not really need, or do costs go down because people get the care that really keeps them healthy?
Researchers are looking into that very question and have come up with some suggestions for policymakers, as NPR's Joseph Shapiro explains.
JOSEPH SHAPIRO: The same questions came up in another expansion of health care just recently. In 2006, Medicare, for the first time, started paying for prescription drugs for seniors. The program was called Medicare Part D. Joseph Newhouse is a Harvard researcher.
Professor JOSEPH NEWHOUSE (Researcher, Harvard University): There was a debate when Part D was being enacted. Proponents of the drug benefit wanted to argue that it would save money elsewhere, even though it would obviously cost money to buy the drugs. And the opponents argued that it would not save money elsewhere.
SHAPIRO: So, Newhouse and his co-researchers went back and studied what happened when people got the new drug benefit. They looked at people who had no drug coverage before, and they looked at people who had just some, but not very much drug coverage. Both groups started spending more on medications. But both groups also spent less on going to doctors and hospitals.
Newhouse says these people got access to preventive care. That kept them healthy, and it ended up saving Medicare money.
Prof. NEWHOUSE: People have better insurance, they use more, and that's true in drugs. And in the case of drugs for chronic conditions that people should be taking their medications to control their conditions such as high blood pressure or diabetes, that can prevent future costs.
SHAPIRO: But there was another group Newhouse looked at: people who already had very good drug coverage and then got more under Medicare. They also spent more on drugs, but unlike the other groups, their visits to doctors and hospitals went up. Newhouse says this suggests that sometimes people can get too much care, especially the elderly, who use more medications than any other group.
Prof. NEWHOUSE: There's some over-prescribing of drugs in the elderly. The elderly frequently have pillbox after pillbox in their medicine cabinet. Some of these drugs may have side effects that can actually raise costs, in the worst case, by precipitating some kind of hospitalization, but in any event, precipitating doctor's visits and monitoring to see what's going on.
SHAPIRO: The cost of the new Medicare drug benefit ended up being less than Congress projected. Tricia Neuman of the Kaiser Family Foundation says it was for reasons that were a surprise.
Ms. TRICIA NEUMAN (Kaiser Family Foundation): There were things that happened that weren't predicted, and one is an overall reduction in the growth in drug spending in the nation as a whole, and people changed their practices. A lot of people switched from brand names to generics, which had an effect on overall spending.
SHAPIRO: So health care is complex and practices by patients and doctors evolve, and that makes it hard to accurately forecast the cost of change. The new research appears in the New England Journal of Medicine.
Joseph Shapiro, NPR News.
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