Cost savings through prevention and wellness
Prevention isn’t health care answer
By Steve Jacob
The Sacramento Bee
September 25, 2007
When Sen. Hillary Clinton, D-N.Y., unveiled her $110 billion health care plan last week, one of her strategies for paying that bill was savings resulting from disease prevention and “wellness.”
As with most presidential campaign program proposals, there were few details on this, such as how prevention is being defined and how much savings would result. But this dubious claim is reminiscent of presidential candidate Ronald Reagan’s pledge to balance the federal budget by eliminating government mismanagement, fraud and abuse. And we know how well that worked. It is hard not to feel like your intelligence is being insulted.
To recast Benjamin Franklin’s aphorism, the argument is that a dime’s worth of prevention today erases a dollar’s worth of cure tomorrow. Some earnest health care reformers echo Clinton in asserting that widespread preventive care and aggressive treatment of chronic conditions result in net savings by heading off larger future medical bills resulting from lack of detection or neglect.
Prevention is a hot topic these days. Medicare officials toured 48 states this summer to promote the program’s extensive menu of reimbursed screenings, inoculations and counseling. The government’s Centers for Medicare and Medicaid Services found that fewer than 10 percent of Medicare recipients were getting the battery of recommended immunizations and screenings, and more than a third failed to take advantage of a free flu shot in 2005.
This rediscovery of Franklin’s centuries-old wisdom is difficult to dispute. But there are some fundamental flaws in seeing preventive care as the Holy Grail for cutting health care costs: People don’t like it. Flu shots and immunizations are not pleasant. Annual checkups are inconvenient, and frequently not covered by insurance. Shedding your vices requires an iron will. A lack of urgency invites inaction.
For health care providers, it isn’t profitable. They get paid to do stuff: surgeries, procedures, lots of patient appointments.
Spending the time to nag you about smoking and excessive food intake doesn’t ring the cash register.
There is no scientific proof that universal preventive care saves money. However, the return on investment is evident when it is targeted at high-risk groups.
A few hospital systems nationally are providing free preventive care to patients who repeatedly visit emergency rooms for expensive treatment for chronic ailments.
Some companies are claiming that “workplace wellness” has a significant payback in reduced absenteeism and health care costs, but the evidence remains elusive.
Safeway has been hailed as a corporate pioneer when its health coverage costs fell 11 percent in 2006 after its 2005 health care costs exceeded its annual net profits. Its preventive health plan includes a 24-hour hot line for medical advice, lifestyle counseling and a 17,000-square-foot fitness facility at its corporate headquarters.
But its first-year savings were exclusively from changing its health insurance plan design. The jury is still out on long-term impact.
No one opposes prevention. As a political stance, none is safer. Well over half of U.S. health care costs stem from individuals’ poor lifestyle choices. Bad habits do not have many advocates.
But relying on people to change them, thus ultimately creating the funds to help cover the uninsured, is a fairy tale.
Universal prevention practices will make us healthier, but they are unlikely to save money.
A 2002 Rutgers University study found that last-year-of-life medical care accounts for 26 percent of Medicare expenditures and 22 percent of all medical expenditures. The real savings in healthcare is in rationing it, especially among those whose imminent death is inevitable.
You won’t find that in any candidate’s position papers.
About the writer:
Steve Jacob is a member of the Fort Worth Star-Telegram Editorial Board and a master’s student in health policy and management at the University of North Texas Health Science Center in Fort Worth.
http://www.sacbee.com/110/story/396210.html
Comment:
By Don McCanne, MD
Prevention and wellness programs are certainly to be encouraged for their beneficial impact on health. They should be an integral part of our health care delivery system. Much more importantly, they should be incorporated into all other appropriate public and private endeavors.
Ranging from educational programs in schools, to safety design of products, to development of community recreation facilities, to food industry marketing of healthier options, and on and on and on, the prospects are almost endless on how we can encourage prevention and promote wellness. Continuing awareness of the possibilities should be made a part of our culture.
But what we should NOT do is allow the dialogue on providing affordable health care for everyone to be diverted away from the well defined deficiencies in our system into some kind of nebulous wellness mumbo jumbo. During this open window of opportunity, we cannot afford to be distracted from our primary mission to reform health care financing for the benefit of all.