I, like most liberals, used to buy the thinking that spending money on prevention actually saves money because you are avoiding more expensive medical procedures down the road. Turns out it’s not really true. At least for most procedures. Does that mean we should forget about prevention? Of course not. Just that, alas, it’s no panacea and, like with the rest of medical care, we need to make sure that our preventative dollars are spent as smartly as efficiently as possible. Sarah Kliff had a nice post summing up the issues last week:
Only 20 percent of those regularly used preventive measures are “cost saving,” reducing costs while improving the quality of health, the research found. The rest tend to buy improved health care but do so at a cost…
“The evidence of hundreds of studies over the past four decades has consistently shown that most preventive interventions add more to medical spending than they save,” Russell concludes…
How can this be? The idea that prevention saves money feels intuitive. “When we think of prevention, we tend to think of the individual who benefited,” Russell writes. We conjure up an image of the woman who caught breast cancer early, averting expensive treatments, or the man who brought his weight down and lived a long, healthy life. That, however, discounts all the mammograms that didn’t detect cancer and didn’t prevent anything and all the individuals for whom weight management programs didn’t work. All those costs add up to the point that most preventive interventions cost more than they save.
Of course, even if it costs more, we certainly should be willing to pay for improved quality of health. And presumably we need to invest even more in that 20%. The research Kliff reviews here concludes that some preventative treatments provide way more bang for the buck than others. In a world of limited health care resources, these are the treatments that should really get our focus. E.g.,
In her chapter, Russell also runs through what $1 million invested in a given treatment buys us in Quality Life Years. Investing $1 million in screening men over 55 for colon cancer would, according to the research, translate into a gain of 577 quality life years. Investing the same amount in cholesterol-lowering medications for high-risk, middle aged men would only translate into 12 additional quality life years. Not all preventive interventions, it turns out, are created equal.
Wow– if as if I wasn’t already skeptical enough about Statins. Of course, if those are your 12 quality life years, you’ll be glad to have them, but if we cannot have everything, I’d like to see my money go towards increasing screenings and those 577 quality life years.
And, of course, in the future, I’ll make sure that I don’t try and argue for more preventative health care as a way to save money. It would be awesome if it did, but I still think it’s worth arguing for dramatically improving many, many persons quality of life through preventative treatment, even if it costs something.