Prevention and wellness - phantom savings and real costs
From: Douglas W. Elmendorf, Director
To: Honorable Nathan Deal, Ranking Member, Subcommittee on Health, Committee on Energy and Commerce, U.S. House of Representatives
Congressional Budget Office
Letter
August 7, 2009
This letter responds to the question you asked at a July 16, 2009, committee markup concerning the Congressional Budget Office’s (CBO’s) analysis of the budgetary effects of proposals to expand governmental support for preventive medical care and wellness services.
Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.
Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness.
Wellness services include efforts to encourage healthy eating habits and exercise and to discourage bad habits such as smoking.
… obesity is the end result of several interacting factors that are not all intrinsically unhealthy. One of those factors is obviously diet, which can be hard to regulate because many foods are safe to eat in moderation. Another key factor is lack of exercise, a bad habit that — like a poor diet — can be difficult for individuals to change and is particularly difficult for policymakers to influence. Approaches for losing weight reflect those difficulties: A variety of interventions appear to succeed in the short run, but relatively few participants are able to maintain their weight loss for a long period of time.
http://www.cbo.gov/ftpdocs/104xx/doc10492/08-07-Prevention.pdf
And…
The Impact of Prevention on Reducing the Burden of Cardiovascular Disease
By Richard Kahn, PhD; Rose Marie Robertson, MD, FAHA; Robert Smith, PhD; David Eddy, MD, PhD
Circulation
2008;118:576-585
Aggressive application of nationally recommended prevention activities could prevent a high proportion of the (coronary artery disease) events and strokes that are otherwise expected to occur in adults in the United States today. However, as they are currently delivered, most of the prevention activities will substantially increase costs.
http://circ.ahajournals.org/cgi/reprint/118/5/576
And…
Does Preventive Care Save Money?
By Joshua T. Cohen, Ph.D., Peter J. Neumann, Sc.D., and Milton C. Weinstein, Ph.D.
The New England Journal of Medicine
February 14, 2008
Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.
http://content.nejm.org/cgi/reprint/358/7/661.pdf
Comment:
By Don McCanne, MD
Prevention and wellness programs frequently can be very beneficial for our physical health and our sense of well being, and when they are, they may well be worth the investment of our time and money.
What is troublesome is that Congress and the administration have chosen the most expensive model of health care reform, and they are pretending that the savings from prevention and wellness will be a major source of financing that reform. They contend that much of the benefit allegedly would be beyond the ten years budgeted, because it would take that long to realize the savings. But almost all studies indicate that the hoped for savings will never materialize. We’ll be spending more instead.
Yes, improved prevention and wellness programs should be a goal of our health care reform efforts, but the two most urgent goals are to include everyone and to make health care affordable.
Including everyone is easy. Simply make enrollment automatic for everyone.
Affordability is much more difficult, but you do not begin by choosing the most expensive model of reform, then adding programs that cost yet more money, and then pretending that they will magically reduce costs well off into the future when there is no evidence to support that wish-it-were-true policy.
The first and most important step toward attaining affordability would be to reject the most expensive model of financing health care, and instead enact the least expensive model which also happens to be the most effective: a single payer, Medicare-for-all national health program. The task of improving prevention and wellness programs would be much simpler and less expensive under such a model.