PREVEN­TION DIS­SEN­SION

High front-end ex­pense of preven­tion pro­grams may de­rail their wide­spread use and prom­ise of fu­ture cost sav­ings

Modern Healthcare - - Front Page - Rich Daly

So is an ounce of preven­tion re­ally worth a pound of cure?

It cer­tainly is for in­di­vid­u­als. But most preven­tion pro­grams are likely huge cost driv­ers for pay­ers such as the fed­eral gov­ern­ment. And that par­tic­u­lar payer plans to wres­tle with mas­sive and grow­ing health­care costs this sum­mer as part of an ef­fort to con­trol run­away bud­get deficits.

With the prospect of a gru­el­ing sum­mer­long battle over health­care’s role in fu­el­ing the deficit, fed­eral of­fi­cials are mak­ing the highly in­tu­itive yet sci­en­tif­i­cally shaky ar­gu­ment that preven­tion pro­grams ul­ti­mately will save the gov­ern­ment money.

“Clearly, we have to get our bud­get un­der con­trol and some of that is go­ing to re­quire painful choices, but one of the things that we want to make clear is that preven­tion is a best buy,” Dr. Thomas Frieden, di­rec­tor of the Cen­ters for Disease Con­trol and Preven­tion, said in an in­ter­view. “In pub­lic health we have the abil­ity to re­duce the num­ber of peo­ple who smoke or are obese or who have di­a­betes, and that can have a huge im­pact on our health­care costs.”

The cost-sav­ing premise of preven­tion pro­grams has be­come part of the re­sponse of se­nior ad­min­is­tra­tion health­care of­fi­cials—in­clud­ing Dr. Fran­cis Collins, di­rec­tor of the Na­tional In­sti­tutes of Health, and Sur­geon Gen­eral Dr. Regina Ben­jamin—as Repub­li­cans have tar­geted health­care pro­grams, in­clud­ing high-pro­file preven­tion pro­grams, in their quest to dis­man­tle the Pa­tient Pro­tec­tion and Affordable Care Act and sig­nif­i­cantly rein in fed­eral spend­ing.

Al­though the pres­i­dent and Se­nate Demo­cratic lead­ers vow to stop such mea­sures, pas­sage in at least one leg­isla­tive cham­ber in­creases the chances that Repub­li­cans could roll them into spend­ing bills that be­come law.

Case for preven­tion

The cham­pi­oning of preven­tion as a mat­ter of eco­nomic pru­dence echoes ar­gu­ments dur­ing the fight for pas­sage of the Pa­tient Pro­tec­tion and Affordable Care Act that the mea­sure would lower long-term health­care costs by im­prov­ing the pop­u­lace’s health. That would be achieved, pro­po­nents said, by ex­pand­ing in­surance cov­er­age (en­sur­ing more peo­ple get care be­fore they have acute med­i­cal needs) and with an ar­ray of other pro­vi­sions.

“These sav­ings can be achieved by stan­dard­iz­ing qual­ity care, in­cen­tiviz­ing ef­fi­ciency, in­vest­ing in proven ways not only to treat ill­ness but to pre­vent them,” Pres­i­dent Barack Obama said in a May 11, 2009 speech.

In ad­di­tion to spe­cific preven­tive-care ini­tia­tives (See chart), the law elim­i­nates out-ofpocket ex­penses for preven­tive-care vis­its for Medi­care ben­e­fi­cia­ries and re­quires that pri­vate in­sur­ers do the same.

On April 13, the House of Rep­re­sen­ta­tives voted to re­peal the law’s Preven­tion and Pub­lic Health Fund, which au­tho­rizes the HHS sec­re­tary to dis­trib­ute $17.75 bil­lion from 2012-21. Democrats re­sponded that Repub­li­cans were acting cyn­i­cally to cut spend­ing on preven­tion while claim­ing fis­cal re­spon­si­bil­ity as their top pri­or­ity.

“For decades our health­care sys­tem has been de­signed to treat pa­tients once they’re sick,” Rep. Anna Eshoo (D-Calif.) said in an April House floor speech. “This is in­ef­fi­cient and costly. The Preven­tion and Pub­lic Health Fund in­cluded in health­care re­form is fi­nally start­ing to change this back­ward sys­tem and in­vest in ef­forts to keep peo­ple healthy.”

It’s a sim­ple and pow­er­ful ar­gu­ment. And for some types of preven­tion ini­tia­tives, such claims are in­dis­putably true.

The wide range of ac­tiv­i­ties en­com­passed un­der “preven­tion” in­cludes many clin­i­cal ser­vices, such as vac­ci­na­tions or pre­scrip­tion med­i­ca­tions that help peo­ple quit smok­ing and thus pre­vent disease. Some of these pri­mary preven­tion pro­grams are rel­a­tively in­ex­pen­sive and can elim­i­nate the fu­ture cost of treat­ing ex­pen­sive dis­eases, ac­cord­ing to re­cent stud­ies.

AP PHOTO

First lady Michelle Obama vis­its a school as part of the White House’s Let’s Move cam­paign, an ef­fort by the ad­min­is­tra­tion to make Amer­i­cans health­ier.

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