We're talking about saving $900,000 or more for just one patient. It would take a lot of checkups for a lot of people to equal that amount.
To get the one case of that prevention you do have to have a lot of checkups, and not just checkups, but diagnostic tests and procedures.
Most will go through the checkups, without any sign of cancer. Most of them won't have it. Some of them will, but the extra checkups won't detect any sign of it.
When there is some sign, you go to the next level. Some wont' have it, and after more tests it will be confirmed. Some will have it but will get false negatives on the next level. Some will have cancer but it will be at a stage that can't realistically be treated. For some of those people treatment will be done anyway often without significant benefit. Others will have slowly developing cancer that would not develop fast enough to cause significantly problems before they die of something else. Others will have treatable cancer but it still will be detected late enough to need the $900K or whatever additional treatment.
Then you get some who get less costly treatment. You saved a lot of money on them avoiding the more expensive treat, only if 1 - They would have been treated anyway, which may not be the case, 2 - The cheaper treatment is effective, and things don't advance to need the more expensive treatment.
Then on top of all of that you have to consider additional tests and even sometimes treatment for false positives for diseases or disorders. And complications from treatment that may not be needed.
Some types of preventive care do save money, but a lot of ways people get preventive care does not save money.
Also once again, "doesn't save money", doesn't mean "is a bad thing" or "shouldn't be done". There are a range of preventive care options that probably won't save money but can produce better health care outcomes. (And there are some that are questionable even by that metric, some of which get labeled under "defensive medicine".)
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When Preventive Care Costs More
By MICHELLE ANDREWS
Many politicians are betting that pending health care legislation will save taxpayers billions of dollars by increasing support for preventive care and ultimately reducing the need for expensive medical interventions in the years to come. But a new study adds to the evidence that while preventive health care may save lives, it does not necessarily save money.
The report, published online this week in the journal Health Affairs, projected that people with Type 2 diabetes who participated in a disease management program to prevent serious complications would cost the federal government slightly more money over 25 years than they would have without any intervention. The management program would save money only among the youngest participants in their 20s, the researchers found.
Diabetes is exactly the sort of chronic condition in which experts would expect preventive care to have a positive financial impact. Disease management programs that help patients keep their blood pressure and blood sugar levels in check and encourage them to get regular foot and eye exams can help forestall or even prevent expensive complications, like kidney failure, amputation, blindness and stroke.
But while these programs may be a boon to patients’ health, the study estimated that the cost savings would generally be offset by the cost of the program itself, estimated at $1,024 annually per patient.
Improved health might be reason enough to finance preventive care programs, the authors noted. “Even though you don’t save money, you recoup a lot of your costs and you get good clinical results,” said one of the study’s authors, Michael O’Grady, a senior fellow at the National Opinion Research Center.
Mr. O’Grady and his colleagues also noted that for chronic diseases like diabetes, it made more sense to estimate the financial impact of preventive interventions over 25 years rather than the 10-year window that the Congressional Budget Office uses to calculate financial impacts. Looking further into the future, they say, yields a truer sense of the cost-benefits ratio.
Still, even the long view did not show that a prevention program like this saves money. Preventive care may well be like any other kind of medical care — expensive now, and in years to come.
prescriptions.blogs.nytimes.com
However, according to an AP article this morning, preventive care may make sense, and it may save lives, but it won't save money:
Studies have shown that much preventive care — particularly tests like the ones Obama mentions — actually costs money instead of saving it. That's because detecting acute diseases like breast cancer in their early stages involves testing many people who would never end up developing the disease. The costs of a large number of tests, even if they're relatively cheap, will outweigh the costs of caring for the minority of people who would have ended up getting sick without the testing.
The Congressional Budget Office wrote in August: "The evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall."
This, of course, doesn't mean that preventive care isn't a good thing, it certainly is. But it is disingenuous for Obama, Pelosi, et. al., to claim it will reduce the cost of overhauling health care.
examiner.com
Does Preventive Care Save Money? Health Economics and the Presidential Candidates
Joshua T. Cohen, Ph.D., Peter J. Neumann, Sc.D., and Milton C. Weinstein, Ph.D.
content.nejm.org
Congressional Budget Expert Says Preventive Care Will Raise -- Not Cut -- Costs
August 09, 2009 9:27 AM
In yet more disappointing news for Democrats pushing for health care reform, Douglas W. Elmendorf, director of the Congressional Budget Office, offered a skeptical view Friday of the cost savings that could result from preventive care -- an area that President Obama and congressional Democrats repeatedly had emphasized as a way health care reform would be less expensive in the long term.
Obviously successful preventive care can make Americans healthier and save lives. But, Elmendorf wrote, it may not save money as Democrats had been arguing.
"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," Elmendorf wrote. "That result may seem counterintuitive.
"For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending — for that individual," Elmendorf wrote. "But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. ... Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."
blogs.abcnews.com
Campaign Myth: Prevention as Cure-All
By H. GILBERT WELCH, M.D
Published: October 6, 2008
In a presidential campaign that promises straight talk and no gimmicks, why do both candidates champion one of medical care’s most pervasive myths?
The myth is that like magic, preventive medicine will simultaneously reduce costs and improve health.
Senator John McCain argues that “the best care is preventative care,” and his health care reform plan claims that “by emphasizing prevention” and other measures “we can reduce health care costs.” Senator Barack Obama’s plan says, “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.”
It may sound like common sense. But it is still a myth.
The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach.
But the medical model for prevention has become less about health promotion and more about early diagnosis. Both candidates appear to have bought into it: Mr. Obama encourages annual checkups and screening, Mr. McCain early testing and screening.
It boils down to encouraging the well to have themselves tested to make sure they are not sick. And that approach doesn’t save money; it costs money.
Increasing the amount of testing for an ever-expanding list of problems always identifies many more people as having disease and still more as being “at risk.” Screening for heart disease, problems in major blood vessels and a variety of cancers has led to millions of diagnoses of these diseases in people who would never have become sick.
Likewise, recent expansions in the definitions of diabetes, high cholesterol and osteoporosis defined millions more as suddenly needing therapy. A new definition of “abnormal bone density,” for example, turned 6.8 million American women into osteoporosis patients literally overnight.
These interventions do prevent advanced illness in some patients, but relatively few. Any savings from preventing those cases is dwarfed by the cost of intervening early in millions of additional patients. No wonder pharmaceutical companies and medical centers see preventive medicine as a great way to turn people into patients — and paying customers.
If preventive medicine were effective in improving the nation’s health, it might warrant these added expenditures. But you can’t assume it is. Early diagnosis may help some, but it undoubtedly leads others to be treated for “diseases” that would never have bothered them. That’s called overdiagnosis.
Early screening is like the “check engine” light in your car. It can alert you to problems that need to be fixed, but too often it picks up trivial abnormalities that don’t affect performance, like one sensor’s recognizing that another sensor isn’t sensing.
And if we look hard enough, we’ll probably find out that one of your check-engine lights is on.
Overdiagnosis occurs even among what were once considered uniformly deadly diseases.
When it comes to cancer, for example, there is a very broad spectrum of diseases. Some kill rapidly, some progress slowly, and some do not progress at all.
That is why some doctors recommend “watchful waiting” for men with early prostate cancer: most cases never prove fatal. It was because of concerns about overdiagnosis that the United States Preventive Services Task Force recently recommended against prostate cancer screening in men over 75. Similar phenomena have been documented in early-stage breast cancer, lung cancer and melanoma.
Most diseases exist along a similar spectrum. Even without treatment, most cases of aortic aneurysm never result in a fatal rupture, most patients with osteoporosis won’t fracture their hip, and most people with diabetes won’t lose a limb.
It’s hard to ignore a “check-engine” light. Some mechanics reset them and see if they come on again, but often they lead you to a repair. And you may have had the unfortunate experience that a repair makes matters worse.
If so, you have some feel for the problem of overdiagnosis. Almost everybody with a diagnosis undergoes treatment. And all of our treatments have some harms. From 1 to 5 percent of patients die after major surgery, and as we are all increasingly aware, prescription medicines carry real risks. Recent experiences with hormone replacement (breast cancer) and Vioxx (heart attacks) are potent reminders that our “best” new treatments may harbor unpleasant surprises.
For those who are ill, the potential benefits typically overwhelm the potential harms. But the calculus is different for those recruited to consume preventive medicine: those who are well. They are the ones at risk for overdiagnosis — and overdiagnosed patients can’t benefit from prevention, because there is nothing to prevent. Instead, they can only be harmed.
Both presidential candidates need to challenge the conventional wisdom about preventive medicine. They should ask whether the path to a healthy society is the one that turns those who are well into patients anxious about their future. They should inquire whether more diagnoses will lead to more unnecessary treatment. And they should question whether suggestions that preventive medicine will save money — and fix the health care system — pass the tests of evidence and logic.
H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H., is the author of “Should I Be Tested for Cancer? Maybe Not and Here’s Why” (University of California Press).
nytimes.com
Preventive care doesn't save money
Froma Harrop
The Providence Journal
July 18, 2008
The word "prevention" has a nice ring in any health care discussion. Thus, many politicians argue that programs to stop smoking, improve diets and otherwise promote wholesome living save money in the long run. A healthier population at less cost – sounds like a win-win situation.
Unfortunately, that formulation is a pleasant fantasy.
Medical economists agree that cancer screenings and gym classes can lead to physical well-being and longer lives. But in the interests of honest accounting, they add that prevention does not reduce overall health care spending. On the contrary.
Let's put it bluntly: Longer lives cost more money. Those who make it to 90, thanks to exercise and six daily servings of vegetables, are more likely to suffer the expensive ravages of old age. Everyone dies of something. So he who avoids a fatal heart attack at 70 is more at risk of cancer at 80. Those extra 10 years can mean extra CT scans, hip replacements and physical therapy, even for those in relative good health.
Despite this reality, the cost-saving virtues of wellness programs echo along the presidential campaign trail. Democrats Hillary Clinton and John Edwards talked them up, as did Republican Mike Huckabee. The presumptive major-party nominees, Democrat Barack Obama and Republican John McCain, both include "prevention" in their health care proposals.
"Prevention is absolutely the right thing to do," Arthur Garson Jr., the provost at the University of Virginia Medical School, told me. "The issue is, do not expect to get to the end of the day and have enough money from prevention savings to pay for the uninsured."
Author of the book "Health Care Half Truths," Garson cites a recently published study on the high cost of healthy people. Dutch researchers found that medical spending on smokers, who died at an average age of 77, was $100,000 less than on nonsmokers who were thin and died at 84.
Companies that include wellness programs in their employee benefits may indeed see a savings in lower medical costs and absenteeism. But what they have done, really, is delay the onset of serious illness during the employees' working years and pass it on to Medicare, when the taxpayers take over.
A study reported in the New England Journal of Medicine finds that only 19 percent of preventive interventions save money. Their value depends on the particular intervention and the sort of people who get it. "For example, drugs used to treat high cholesterol yield much greater value for the money if the targeted population is at high risk for coronary heart disease," write the authors, Joshua T. Cohen, Peter J. Neumann and Milton C. Weinstein.
Rapidly rising prices for health care also add to the expense of moving big-ticket medical procedures into later years, explains Garson, a cardiologist. "In today's world, where the rate of medical care inflation is twice the rate of regular inflation, anything done 10 years from now is, in real dollars, 25 percent more expensive."
There are two ways to deal with that problem, according to Garson. Get medical costs down, and "keep people as healthy as possible as long as possible so that they don't spend as much money being sick."
The best kind of aging, he says, is to "have early old age last as long as possible and late old age last 15 minutes."
Yes, preventive care is a good thing because a long and healthy life is a good thing. We shouldn't lose sight of that big picture. But let's not deceive ourselves into believing that wellness programs can reduce medical spending over the long haul. That may come off as an attractive selling point for a health care plan, but it's not so.
spokesmanreview.com |
