The Facts on Preventative Care
A popular health care talking point is the advantages of expanding preventative medicine. So far, the Affordable Care Act (ACA) has an impressive record on this front.
According to HealthCare.gov:
"In 2011, 424,007 people with Medicare in Minnesota received free preventive services – such as mammograms and colonoscopies – or a free annual wellness visit with their doctor. And in the first five months of 2012, 129,126 people with Medicare received free preventive services."
The ACA helped more than 1 million Minnesotans with private health insurance receive preventive service coverage.
Expanding access to preventative care represents a significant advance in health care delivery in the United States, but not for the reasons you think.
Probably one of the most common justifications preventative care expansion is that it saves money. The logic makes sense: catch problems early before they become expensive conditions. But the evidence is a bit more muddled. The confusion probably results from a terminology issue. The Robert Wood Johnson Foundation points out that “cost-saving” and “cost-effective” have two different meanings. Cost-saving refers to care that decreases costs. Cost effective is if the benefits are equivalent to the costs, even though it might not save money.
Here is where the conventional wisdom takes an interesting turn. A New England Journal of Medicine study conducted a literature review surrounding preventative care and concluded: “Some preventive measures save money, while others do not, although they may still be worthwhile because they confer substantial health benefits relative to their cost. ” Childhood immunization, smoking cessation, and aspirin for people at risk for heart attacks have been shown to be examples of cost-saving services.
But the study hit another important point. Is savings necessarily the best measure for the value of preventative care? Steve Woolf, Director of Virginia Commonwealth University’s Center for Human Needs, argues, “The proper question for a preventive (or therapeutic) intervention is how much health the investment purchases. ” The standard measure is that a procedure is cost effective if it costs less than $75,000 per quality-adjusted life year (QALYs).
Will this investment make people healthier? Or will side effects from invasive testing or other procedures make us less healthy in the long run and decrease our quality of life?
It's a discussion that few want to participate in, and conservatives will attack such dialog as "death panels." But it's a decision that insurance companies are evaluating already, far out of public view, with little or no input from those that will be impacted by it, and with a very different set of priorities.
So it's time, do we have a reasonable, but difficult public debate or do we pretend it's not happening and let the privileged few make the decision for all of us?