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Tuesday, September 16, 2008

Weighing an Ounce of Prevention

Preventative health care is a huge part of employee wellness programs—not to mention a major focus of this year’s presidential campaigns. But how much do measures like cancer screening actually reduce health care costs?

Not as much as you may think, according to a recent article in The New England Journal of Medicine, which found that preventive-care programs usually result in higher payouts, not lower ones.

Newsweek’s Mary Carmichael recently spoke with two of the paper's authors, Peter Neumann and Joshua Cohen, both health-policy researchers at Tufts Medical Center, about “the politics of prevention” and related issues.

I highly recommend reading the full transcript, but here are some interesting excerpts:

Why do politicians like preventive care so much?

COHEN: Because it sounds like common sense. We've all heard "an ounce of prevention is worth a pound of cure."

Too broad, according to your paper.

NEUMANN: The blanket statement that prevention will save money and improve health is too simplistic. Sometimes it saves money, sometimes it doesn't.

What's an example of preventive care that does save money?

COHEN: One is childhood immunization on the recommended schedule. The problem is that a lot of kids are already on that schedule—we've gotten the bang for that buck. Another is the use of aspirin in middle-aged people to decrease their risk of cardiovascular disease. If you target the right people, you could actually save money and make people's health better.

But only 19 percent of the preventive interventions you looked at ended up saving money. Some cost a lot more.

NEUMANN: One example is prostate-cancer screening. It seems to be inefficient.

Prevention also isn't very precise. Once a person is sick, we know he needs help—

NEUMANN: Whereas it's not always clear who's going to be a train wreck in the future. When you intervene early you pick up train wrecks, but also people who were slightly at risk or weren't at risk at all. Also, part of what advanced medicine helps us do is detect small risks, and we're going to pay for that. As we gain more ability to detect small risks and intervene when we find them, costs will go up.

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