Prevention efforts have little success in reducing illness, cost

Jun 13 2009

As health reform heats up, many lawmakers agree that the government should take a larger role in preventing disease. However, the Wall Street Journal reports that "many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs."

The paper notes: "The problem is that when testing becomes too widespread, or heavy investments are made in monitoring people with chronic diseases, the rewards often fail to match the costs... The results are striking because of the broad consensus in Washington that it is cheaper to invest in keeping people healthy than it is to treat them once they are sick." However, "the Congressional Budget Office, in a December report, concluded that greater use of preventive care would at best generate modest reductions in costs over 10 years, and might even result in increases."

The Wall Street Journal also points to other research. "A report published in the New England Journal of Medicine last year examined 279 spending ratios in published studies of health-oriented prevention measures, and another 1,221 on treatments for people who were already sick. Some measures clearly saved money, like screening men in their early 60s for colorectal cancer. But the report concluded that most preventive measures reviewed didn't save money. For instance, screening all 65-year-olds for diabetes would cost $590,000 for every healthy year of life it adds over just screening people that age with high blood pressure. Medicare has conducted seven pilot programs in the past decade testing the theory on some of the most costly chronic diseases. Each showed little if any cost savings or measurable improvement in patients' health."

"Nonetheless, private health insurers are placing bets that prevention can lower their costs," The Wall Street Journal reports. Meanwhile, "some experts point out that focusing on savings is the wrong way to think about prevention" while others point out possible hurdles such as the difficulty of creating lifestyle changes and that money spent on disease prevention often goes to people who aren't sick" (Adamy, 6/12).

CNN reports on the relationship between life expectancy and preventive health in the U.S. CNN notes: "Despite spending more money than any other country on health care, the United States does not lead the world in life expectancy, a long-known fact that some experts say could raise more questions in the health-care reform debate. The United States ranks 50th out of 224 nations in life expectancy, with an average life span of 78.1 years, according to 2009 estimates from the CIA World Factbook. Some argue part of the problem stems from the privatized nature of the U.S. health care system, whose reform is being vigorously debated on Capitol Hill." CNN also notes that in countries where individuals pay for their own care, people often don't get treatment until their symptoms have become serious and that there is less emphasis on preventative care in those countries (Landau, 6/11).

Meanwhile, the New America Foundation reports that hospitals are cutting back on infection prevention efforts, which have been seen as a major goal of the health care quality movement. It reports: "the recession is forcing some hospitals to cut back on their infection control budgets... Some of these infections can be mild; others are fatal. The CDC estimates that about 1.7 million people acquire some form of infection in the hospital each year; nearly 100,000 die. They also add billions of dollars to our health spending. In a survey of 2,000 infection preventionists - conducted by the Association for Professionals in Infection Control and Epidemiology - 41 percent reported cuts in funding for infection-prevention efforts in the past 18 months due partly to the struggling economy ... Half saw reductions in overall budgets for infection prevention, including money for technology, staff, education, products, equipment and updated resources" (Mazerov, 6/11).