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« The Economic Earthquake of 2008; Implications, Vulnerabilities and Aftershocks | Main | Don't Take Out a 401k Loan »

September 29, 2008

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I agree that preventative health care is great and well worth the investment. However, I am not convinced that increased spending, either from the government or elsewhere, can do too much more to prevent diabetes, heart disease, and cancer. Unless I am mistaken, the best way to avoid these is to eat a health diet, maintain a healthy weight, and get plenty of exercise. Most of us know this, but do we do it?

RDS

Part of the reason that health care costs so much is that preventative care is not taken. When someone gets sick, and doesn't have health insurance, he or she is reluctant to go to the doctor until it gets bad enough to go the emergency room.

It's not all just about diet and exercise (especially in terms of Type 1 diabetes). There are issues at play as well. My uncle is a textbook case in terms of diet and exercise every day of his life. He has had leukemia AND a malignant tumor on his thyroid. If he can get cancer, anyone can, regardless of what they do to the contrary.

At any rate, part of prevention is just having regular checkups that many w/o health care avoid. These regular checkups would allow doctors to educate and monitor their patients. Maybe doctors could even get bonuses for helping patients live healthier, rather than getting kickbacks for prescribing certain drugs or denying treatment.

The issues about preventative care saving money aren't as simple as people realize. There was an article in New England Journal of Medicine that specifically looked at it - I don't have time to search for it now, I may post the link later this evening. Their conclusion - some preventive measures save money others - even those that benefit people - not only don't save money but are actually quite expensive.

What most people miss when they talk about prevention of chronic conditions is that in many cases one need to screen/treat (e.g. with preventive drugs) hundreds, sometimes thousands of people for many years for one person to benefit. Since most of the tests aren't perfect, there are false positives. The false positives lead to more expensive (and invasive tests) that not only cost money but may have actual risks. So the costs add up. Also, the reason some of the tests that are done on annual physicals are not recommended is because there is no evidence that they have any benefit at all. Yet doctors do them both because they don't want to be sued in case they miss something but also because they may work for a medical group that wants "utilization" of lab facilities; or because some insurance company wouldn't consider a checkup a checkup unless a test is done (I saw a doctor specifically mention this being his reason for doing a non-recommended test).

As I promised, here is the article from New England Journal of Medical that specifically looks at various preventive measures and studies to determine if they save money: http://content.nejm.org/cgi/content/full/358/7/661

One thing to keep in mind is that in the language of epidemiological studies and medicine, cost-effectiveness isn't the same as cost-saving. A measure is considered cost-effective when the cost of QALY (quality-adjusted life year) is under 50K. Now, I am sure most of us would consider 50K for a good quality year of life a good value, but it is not the same as cost-saving. Some measures may be both cost-effective and cost-saving, but some may be cost-effective but not cost-saving. Just to avoid confusion because sometimes people see cost-effectiveness mentioned and think it is the same thing as cost saving. It is not.

Abstract of the study that showed the frequency and cost of non recommended tests (tests for which there is AGAINST recommendation) during routine physical exams:
http://linkinghub.elsevier.com/retrieve/pii/S0749379706000833

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