G. Prevention
V. Key Issues: Population Health >> G. Prevention (last updated 1.16.17)
Topic Outline
Key Questions
How Much Does the U.S. Spend on Prevention?
It is often asserted that the U.S. spends 3% on prevention, which is the estimated share of National Health Expenditures that goes to government public health activities (3.3% in 2013, falling to 3.1% by 2021). However, Altarum researchers have produced annual estimates of the share of national health expenditures going to prevention, finding that this share has been close to 9% in recent years when all the elements of primary and secondary prevention are included – significantly larger than the commonly cited figure of 3%.
Does Prevention Pay for Itself?
A common misconception is that prevention is literally self-financing, producing downstream medical cost savings that entirely offsets front-end prevention expenditures. The available evidence suggests that prevention is unlikely to reduce total health expenditures for two reasons:
- High Cost of Number Needed to Treatment Per Event Averted. For the individual patient whose heart attack is prevented by a cholesterol screening, to give one example, that blood test is a cost-saver. But to prevent one heart attack, the health care system has to test hundreds of healthy people — and give about a hundred of them cholesterol-lowering drugs for at least five years. Added together, those prevention measures cost more than is saved on the one heart attack treatment. (Aaron E. Carroll and Austin Frakt have written a helpful article on this concept, known in medicine as the “number needed to treat.”)
- High Cost of Survivors. Moreover, additional spending by survivors will generally exceed whatever reduction in costs is achieved for the particular disease or condition being prevented (e.g., obesity).
“It’s a nice thing to think, and it seems like it should be true, but I don’t know of any evidence that preventive care actually saves money,” said Jonathan Gruber, an M.I.T. economist.
While prevention typical does not save money, prevention often is very cost-effective, meaning that the net cost per quality-adjusted life year gained is lower than for many medical interventions. Here is a sample of the best literature demonstrating these propositions:
- Russell LB. Preventing chronic disease: an important investment, but don’t count on cost savings. Health Aff (Millwood). 2009;28(1):42–45.
- Kahn R, Robertson RM, Smith R, Eddy DM. The impact of prevention on reducing the burden of cardiovascular disease. Circulation. 2008;118(5):576–585.
- van Baal PH, Polder JJ, de Wit GA, et al. Lifetime medical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med. 2008;5(2):e29.
- Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med. 2008;358(7): 661–663.
- PolitiFact.com. Barack Obama says preventive care ‘saves money’ (2.12.12). Statement rated False by Truth-o-Meter.
Preventive Health Services
1. Clinical Preventive Services
2. Oral Health Care
3. High Blood Pressure Control
4. Family Planning
a. Abortion
b. Birth Control
c. Sterilization
5. Infant Health
6. Maternal Health
7. Immunization
a. Human Papilloma Virus
8. STD Prevention
9. HIV/AIDS Prevention
Resources
- Altarum Institute, Center for Sustainable Health Spending. Modeling Prevention, Treatment, and Research Tradeoffs. Under a National Institutes of Health grant, Center researchers are developing a dynamic model of the impacts of alternative investments in treatment and prevention of cardiovascular disease. We hope to improve knowledge of the ways in which alternative allocations of funds interact to produce effectiveness associated with such allocations. The model will include downstream impacts of investments in research to develop new treatment and prevention interventions. It will also incorporate policy resistance which reduces the effectiveness of interventions as individuals engage in unhealthy behaviors as a result of improved prevention and treatment options.