Comments on: DOCTOR IS IN: Common sense and science agree — an ounce of prevention works http://blogs.ajc.com/better-health/2009/07/20/doctor-is-in-common-sense-and-science-agree-%e2%80%94-an-ounce-of-prevention-works/ Advice and suggestions for taking care of you and your family Mon, 27 Sep 2010 23:18:14 -0400 http://wordpress.org/?v=2.8.4 hourly 1 By: Emory University Institute for Advanced Policy Solutions/Center for Entitlement Reform http://blogs.ajc.com/better-health/2009/07/20/doctor-is-in-common-sense-and-science-agree-%e2%80%94-an-ounce-of-prevention-works/comment-page-1/#comment-1137 Emory University Institute for Advanced Policy Solutions/Center for Entitlement Reform Fri, 24 Jul 2009 15:09:25 +0000 http://blogs.ajc.com/better-health/?p=857#comment-1137 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. 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.

]]> By: David Harlow http://blogs.ajc.com/better-health/2009/07/20/doctor-is-in-common-sense-and-science-agree-%e2%80%94-an-ounce-of-prevention-works/comment-page-1/#comment-1099 David Harlow Mon, 20 Jul 2009 21:04:07 +0000 http://blogs.ajc.com/better-health/?p=857#comment-1099 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 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

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