Getting The Most Out Of Preventive Care One of the many points of contention in the health reform debate is whether preventive care actually saves money. Dr. Douglas Kamerow says that in most cases, it doesn't. But he suggests many ways to get more value out of that ounce of prevention.

Getting The Most Out Of Preventive Care

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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 have 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.

A little background: there are three kinds of prevention. Primary prevention takes place before you have a disease and actually prevents it. Childhood immunizations, for example, are our 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 use condoms as a result, you're preventing a disease.

Secondary prevention is early detection of an existing disease when it is asymptomatic, so you have a much better chance that treatment will cure it. Screening tests are the 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 disease so that you don't develop known 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 for some diseases is actually less than what it would have cost to treat those diseases if they had developed in some of those 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.

Douglas Kamerow is a family physician and preventive medicine specialist. He is a chief scientist at the research institute RTI International and a former Assistant Surgeon General. He lives in Maryland. Jimmy Crawford/RTI hide caption

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Jimmy Crawford/RTI

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 Woolf of Virginia Commonwealth University and others argued in a recent paper on this subject, the question of whether prevention saves money and 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 (NOT cost-saving) high-value interventions. 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, needs to be a part of a reformed health care system.

Douglas Kamerow is a family physician and preventive medicine specialist. He is a chief scientist at the research institute RTI International and a former Assistant Surgeon General. He lives in Maryland.