Prevention Isn’t a Cure-All, But It’s a Great Place to Start
One problem with heath care reform is that we speak in platitudes. How many times have we heard the promise to improve quality, lower costs and increase access? This sets unrealistic expectations for reform and, ultimately, its demise when it is shown that the policies can’t deliver.
Prevention is a good example.
Improvements in the health of middle and older aged Americans during the last half century are indisputable products of investments in medical technologies and successful public health efforts to encourage prevention. Efforts to curtail smoking, the development of medications for hypertension and, more recently, statins (cholesterol lowering drugs) are excellent examples.
But there are storm clouds on the horizon. With a growing elderly population — and a larger baby boom generation approaching retirement — the prevalence of chronic diseases will rise. If current trends continue, health care costs will experience a commensurate increase that will consume an ever-increasing share of national income. The future liability of the Medicare program alone is estimated to be $24 trillion over the next 75 years, absent any policy changes.
With this renewed focus on health care costs, policy makers have begun to consider prevention as a place to invest — not only in providing more services but also in research to identify better treatment strategies. Medical or public health interventions in the form of primary prevention should, in theory, have the capacity to slow or reduce the rising prevalence of chronic disease, and simultaneously attenuate the downstream spending associated with it. Thus, if there is a ‘magic bullet’ for rising costs of health care immediately available, basic improvements in population health brought forth by existing treatments may be the best and most economical option.
Unfortunately, when it comes to costs, there is one sad fact that works against prevention – it saves lives. And when people live longer, they spend more money. The best estimates of prevention show that it could save a modest amount of money over a lifetime (maybe 3%). More importantly, however, it can lead to a life that has less disability and more years of active lifestyle. So, while prevention may not save a lot of money, it will make a lot of people feel better, and that, after all, is the point of health care.
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2 Responses to “Prevention Isn’t a Cure-All, But It’s a Great Place to Start”
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I agree with your contention that prevention is critical to a better healthcare system with the result that we will be healthier and thus have a better quality of life.Health care reform needs to address four interrelated issues. Most of the attention has been on access for those without insurance. But just getting an insurance card to all Americans will not mean good healthcare. Today, we have a system that focuses on disease treatment but not health promotion. We have a system that costs far too much, in large part because care is not well coordinated for those with lifelong complex chronic illnesses [e.g., heart failure, diabetes] such that they end up with unnecessary doctor visits, tests, procedures and even hospitalizations. And we are a nation with behaviors that lead to more life long chronic illness – poor nutrition, over weight, under exercised, stressed and 20% still smoke. Meaningful healthcare reform must address the societal issues with incentives to change, the care coordination issue with incentives to primary care physicians to become care coordinators – real orchestrators rather than interveners and assuring access. And we must have incentives to physicians to spend the time needed to assure real preventive care. Access without attention to meaningful attention to improving quality while reducing costs will only mean more people are getting less than appropriate care. More at http://medicalmegatrends.blogspot.com
I too agree that prevention is critical to a better health care system. But if chronic disease is prevented, we will save 85% of all healthcare costs, eliminating the future crisis.
This can be accomplished by eliminating the cultural taboo against insisting on personal lifestyle change, and urgently addressing non-compliance. This is easily and cheaply done, as explained in my site, freehealthreform.com
With such a simple solution, it is time to update our healthcare model to reflect recent data and knowledge.