DOCTOR IS IN: Common sense and science agree — an ounce of prevention works
BY KENNETH E. THORPE, PhD
Robert W. Woodruff Professor and Chair, Department of Health Policy & Management, Rollins School of Public Health, Emory University. Executive director of the Institute for Advanced Policy Solutions/Center for Entitlement Reform. Co-director of the Emory Center on Health Outcomes and Quality. Executive director of the national Partnership to Fight Chronic Disease.
As Congress and the Obama administration work to hammer out the details of health reform, consumers — and by that I mean everyone who has been, is now or will be a patient, or a taxpayer, or both — should pay close attention to prevention.
Both the House and Senate versions of the draft legislation include important investments in prevention, and President Barack Obama has stressed that prevention must be part of comprehensive health reform.
Prevention can be divided into three parts:
1. Things we do to avert disease, like vaccinations for children or obesity prevention programs.
2. Things we do to find and treat disease in its earliest stages, like diabetes screenings or mammograms.
3. And things we do to avoid complications when people are already ill, like making sure care for people who have several chronic illnesses is coordinated among their various doctors.
Research shows scientifically sound prevention programs improve health and save money. Not all prevention programs work, many because they aren’t grounded in science. Not all of them save money. Screening for common and costly diseases, like diabetes, high blood pressure and high cholesterol, may actually raise spending in the short-term, because people who need treatment will get it. But over the long-term, that treatment is likely to avert even more costly complications and avoid higher spending.
Many studies show well-designed prevention programs are cost saving. For example, a significant reduction in total health care spending is linked to community-based lifestyle interventions. An investment of $10 per person per year in community-based programs tackling physical inactivity, poor nutrition and smoking could yield more than $16 billion in medical cost savings annually within five years.
There is evidence from dozens of studies on worksite health promotion programs that prevention programs can work, such as ones to reduce tobacco use, dietary fat consumption, high blood pressure, total serum cholesterol levels and days absent from work due to illness or disability. For example, at Citibank a comprehensive health management program showed a return on investment of $4.70 for every $1 in cost. A similar program at Johnson & Johnson reduced health risks, including high cholesterol levels, cigarette smoking and high blood pressure, and saved the company up to $8.8 million each year.
Anyone who cares about long-term health spending, particularly government health care spending, should support prevention. It’s common sense. And, for once, common sense and science agree: An ounce of prevention really is worth a pound of cure.
Video: Dr. Thorpe discusses how to reduce the number of Americans without health insurance
Institute for Advanced Policy Solutions/Center for Entitlement Reform
Partnership to Fight Chronic Disease
- (Information provided by Emory on this site is intended solely for general educational purposes and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other health provider for any questions you may have regarding your health and medical condition. If you rely on any information available through this website, you do so at your own risk. You understand that you are solely responsible for any damage or loss you may incur that results from your use of or reliance on any material or information provided by Emory through this website.)
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2 comments Add your comment
David Harlow
July 20th, 2009
5:04 pm
I’ve often heard the 4:1 or 5:1 payoff figure cited in support of prevention programs. My impression is that these figures address employment-based health care costs, and thus do not account for post-retirement costs. Given the fact that many of the prevention efforts will not only reduce short-term expenses but increase longevity, it seems that there would likely be a spike in expenses later in life and/or as a result of increased lifespan. Have the employment-based health expense studies accounted for or addressed this issue in any way?
David Harlow
http://healthblawg.typepad.com
Emory University Institute for Advanced Policy Solutions/Center for Entitlement Reform
July 24th, 2009
11:09 am
The return on investment estimates from The Trust for America’s Health are not limited to working-age populations covered by employer sponsored health insurance. The estimates include only direct costs (spending for health care, no matter your age or employment). Indirect cost savings – such as reductions in absenteeism and presenteeism and increases in productivity, which are gained mostly by employers – aren’t included. The ROI estimates are conservative and understated because indirect costs aren’t included. Indirect costs may be as much as four times higher for the most prevalent chronic diseases (cancers, diabetes, hypertension, stroke, heart disease, pulmonary conditions and mental disorders).
Many prevention efforts will actually increase short-term health spending, as diseases are found and treated appropriately. But, over the longer term, increased life span does not automatically lead to increased health care costs. People who enter Medicare healthy have lower lifetime and end-of-life spending than people who don’t. Several studies substantiate this, for example:
Daviglus ML, Liu K, Greenland P, Dyer AR, Garside DB, Manheim L, et al. Benefit of a Favorable Cardiovascular Risk-Factor Profile in Middle Age with Respect to Medicare Costs. N Engl J Med. 1998 October 15, 1998;339(16):1122-9.
Daviglus ML, Liu K, Pirzada A, Yan LL, Garside DB, Greenland P, et al. Cardiovascular Risk Profile Earlier in Life and Medicare Costs in the Last Year of Life. Arch Intern Med. 2005 May 9, 2005;165(9):1028-34.
Daviglus ML, Liu K, Yan LL, Pirzada A, Manheim L, Manning W, et al. Relation of Body Mass Index in Young Adulthood and Middle Ageto Medicare Expenditures in Older Age. JAMA. 2004;43(3):849-68.
Lakdawalla DN, Goldman DP, Shang B. The Health And Cost Consequences Of Obesity Among The Future Elderly. Health Aff Web Exclusive. 2005 September 26, 2005:hlthaff.w5.r30.
Yang Z, Hall AG. Financial Burden of Overweight and Obesity among Elderly Americans: The Dynamics of Weight, Longevity,and Health Care Cost. Health Services Research. 2008 2008:849-68.
It’s expensive to be sick and die in America. The more disease we can prevent or mitigate, the less spending will grow over the long-term, even if more people live longer.