More on the Value of Preventive Medicine

David Brown has an excellent article in the Health section of today’s Washington Post:

Most of us naturally assume that preventing a disease is cheaper than waiting for the disease to appear and then treating it. That belief is especially dear to politicians, who often view prevention as an underused weapon in the battle against health-care costs.

The campaign Web site for Sen. Hillary Clinton (D-N.Y.) notes that her health-care plan is “targeting the drivers of health-care costs, including our back-ended coverage of health care that gives short shrift to prevention.” Rival Sen. Barack Obama (D-Ill.) asserts that American families can save up to $2,500 a year each if five cost-containing strategies are implemented, one of which is “improving prevention and management of chronic conditions.”…

Even when prevention greatly reduces future cases of a particular illness, overall cost to the health-care system typically goes up when lots of disease-preventing strategies are put into practice. This is usually true whether treating the preventable diseases is cheap or expensive.

I raise similar points here and here.

Two points bear clarification, however. First, just because preventive medicine often increases medical spending, that does not necessarily mean (in the words of the article’s headline) that it is “Cheaper To Let People Get Sick.” Illness imposes its own costs, and so it may be cheaper to spend money on preventive care even when doing so increases overall medical spending because the benefits of avoiding illness outweigh the additional spending. But we should not think that spending additional money on preventive medicine would reduce medical spending. Second, contrary to what Brown claims in his first sentence, there very likely was a period in health economics when an ounce of prevention was worth a pound of cure. During the period when public health measures first began to control contagious diseases and foodborne illnesses, prevention probably did deliver health improvements 16 or more times greater than those delivered by treatments for existing conditions.

The article also contains this priceless comment from Louise B. Russell of Rutgers University:

“The point of the medical-care system is to serve people. It is not the point of people to serve the medical-care system.”

Let’s hope that one gets a lot of play in the near future.