What I think the HMO's would want to avoid would be the bypasses, angioplasties, pacemaker/defibrillators, angiograms, and extended stays in the hospital after an infarct. I would think the drugs would be cheap in comparison.
If someone's diagnosed at 45 with the beginning of heart disease the HMO will be on the hook for 20 years of a drug. To make the calculation easy assume that after copay the drug is $100 per month. 20 years at $100 per month is nearly a quarter of a million dollars. If the drug is half that then it's still $120,000. This assumes no increases in the price of the drug and no move to a more effective, more expensive drug as the patient ages. Add in the expense of the (probably) quarterly visits to the doctor for a checkup and prescription renewal, probably at least annual blood lab work, and another heart scan every five (more often?) years.
How many of the people taking this drug would have had a first heart attack and lived before age 65? On everyone else treated, those who would have had first heart attacks after 64, those who would have died, or those who wouldn't have had heart attacks, the HMOs would be spending quite a bit of money with zero return.
Now if the government changes Medicare so that forced coverage starts at the ever-increasing retirement age and more of the heart attacks start occurring before that cutoff age then maybe the HMOs might find it economically advantageous to start preventative care. OTOH, as people become fat aware and eat healthier the average age of the first heart attack can be expected to increase. |
