Or…it’s complicated.
The New York Times today published a story titled, “No, Giving More People Health Insurance Doesn’t Save Money.” A piece of the argument is, as the author Margo Sanger-Katz puts it, “Almost all preventive health care costs more than it saves.”
What do you think? What’s the evidence? Leave aside, for the moment, the “big duh” fact that at least in the long term saving people’s lives in any way will cost more, because we are all going to die of something, and will use a lot of healthcare on the way. Leave aside as well the other “big duh” argument: It may cost money, but that money is worth it to save lives and relieve suffering. Leave that argument aside as well. The question here is: Does getting people more preventive care actually lower healthcare costs for whoever is paying them?
My thoughts? #1: No consultant worth his or her salt trying to help people who are actually running healthcare systems would take such a blanket, simple answer as a steering guide. Many people running healthcare systems across the country are seriously trying to drop real costs, and how you do that through preventive care is a live, complex and difficult conversation all across healthcare.
#2 thought: It depends. It needs analysis. It depends on which preventive tests, screens, and prescriptions you’re talking about, and how it is decided whom to help with them. Sanger-Katz’ article only shows that we cannot assume that every preventive screening or test saves money and/or is worth the money spent. Mammograms, for instance, show no benefit (no extra tumors caught, no lives saved) over breast exams alone (Canadian Breast Cancer Study, n=89,000 over 25 years).
This is true of many preventive items, including the annual checkup — it’s hard to show a true benefit from them. So yes, if you assume that every preventive test, screen, or prescription is worth it, and then you give more people access to those, you’ll end up spending more money. Equally important, the assumption is that you screen everyone, and you do it the most expensive way, like giving older people regular colonoscopies as a test for colon cancer. There are far less expensive ways to pre-screen people for that. This one assumption alone costs an estimated $10 billion per year in the U.S..
The problem is that these assumptions mean giving a lot of medical care, much of it not even effective, to people who are well. There are reasonable ways to narrow the focus of expensive, personal, procedural preventive care and maintenance to the 5% or so who really need it. Find that 5%, give them extra care, and you will save money.
tests don’t improve health – eating healthy and exercising does. there is no easy button. if MD’s are paid based on their patients BMI then they will take interest and get them to lose weight. we are talking about behavior changes of the doctor and the patient. my mom is overweight with multiple chronic conditions and her doctors never says anything about losing weight – he just gives her another pill.
you can lead a horse to water…
Hi Joe,
Thanks for all you do. I am a fan.
Regarding prevention fund d by employers, the ROI comes years after an employee leaves the company plan and goes on Medicare. CFOs are smartening up and realizing their traditional wellness vendors expenses (plus the bribes to the employees to participate) far exceed any claims cost reductions in the under 70 population. Al Lewis offers a $2mm if a traditional wellness vendor can show even one dollar if Claims cost ROI.
Having some well-being programs is the right thing to do, so will be a staple forever, but downsizing these vendor contracts is the norm now. Finding vendors (like PTX Therapy or Quizzify) that guarantee a first year ROI (on claims cost reductions exceeding fees and incentives) to the CFO and also guaranteeing to the HR managers that employee health and well-being will also improve, will become the norm for healthcare 3.0! Traditional wellness vendors are one-trick ponies- only focused on cardiometabolic risk reduction and well-being (which mostly appeals to the “worried well” who spend little). They need to go from being a one trick pony to a three ring circus- add and equally promote musculoskeletal wellness and consumerism (Choosing Wisely) training to cardiometabolic risk reduction. The ROI from musculoskeletal wellness (which costs employers three times what they spend a year on cardiometabolic claims and drugs) and from Health Literacy education can fund the traditional wellness stuff (if it is cut back).
Best regards,
Bob