I don’t think there is any question that preventive care, wellness programs, and early diagnosis and treatment are valuable and that our system needs to move much more in this direction than in continuing to pay more and more to treat people after they become acutely ill.
Nonetheless, I am concerned that the health overhaul law will curtail many of these programs that are already showing positive results. The law will lead employers to focus more on following the rules set by Washington than in continuing to develop and enhance programs with demonstrated success in coordinated and integrated care, including prevention. Just tacking screening tests onto an insurance policy will not get us to the goal of a more efficient health sector that engages patients as partners in managing their health care.
Instead as John Goodman points out, Health Savings Accounts (HSAs) – and other consumer-driven plans – provide incentives for preventive care. They get people more involved in their health care, provide incentives for them to get the best value for their health care dollars, and encourage people to seek out information on quality and price.
Preventive care is most likely to save money and be successful when it is integrated into coordinated care programs that engage patients as partners in their health spending and health care. Smoking cessation medications are most successful if integrated into educational and support programs. Some companies provide diabetics with supplies and medications at no cost if they make monthly visits to care coordinators who can detect early signs of the progression of their illness. Treatment must go beyond providing the medicines to include treatment for secondary issues such as pain and cardiovascular disease in a system of care. Cholesterol-lowering drugs are most likely to be effective when they are combined with a program of diet and exercise. Many private employers and health plans provide incentives for this integrated, coordinated care.
Investments in preventive care are valuable and humane. They save lives and can enhance productivity by treating patients early so they can get back to their jobs and families. But even the Congressional Budget Office says, “[T]he 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.”
Published in National Journal Expert Blogs: Health Care, May 12, 2010.