Au contraire…

A couple of observations from interweb reading this weekend…

We’ve heard/read/thought much about the impact of technology and preventive medicine on health care costs. That they will force them down. And they likely can (and will). But some contrarian thoughts exist…

First, a great thought posted at e-patients: “Technology is always framed as an end and it is not. It is a means. The “end” for most people is getting the information and care they need.” Good stuff.

Second, from the New England Journal of Medicine about preventive medicine (hat tip: Health Populi):

Some preventive measures save money, while others do not, although they may still be worthwhile because they confer substantial health benefits relative to their cost. In contrast, some preventive measures are expensive given the health benefits they confer. In general, whether a particular preventive measure represents good value or poor value depends on factors such as the population targeted, with measures targeting higher-risk populations typically being the most efficient. In the case of screening, efficiency also depends on frequency (more frequent screening confers greater benefits but is less efficient). Third, as is the case for preventive measures, treatments can be relatively efficient or inefficient.

Anyway, as you know if you listen to presidential stump speeches or just catch the highlights on CNN/MSNBC/FOX News/etc. when candidates speak of their health care reforms they tout the benefits of technology investments and preventive medicine. It’s always good to hear something from the other side, especially when thoughts are provided with evidence.

Why hasn’t anyone seriously tried a preventive care delivery model?

As you all know the United States spent $2 trillion+ on health care in 2006. Not that we needed to surpass such a milestone to toke the flames of the how-to-cut-costs debate, but it seems like a good reason to start that conversation here. We’ve been talking about preventive care for a while now and as far as I can tell there hasn’t been much action.   Plus, most of the presidential candidates (save for a couple of republicans) claim (on their websites) cost savings would be generated if we only utilized preventive care.

A quick Google search didn’t turn up any specific citations of how much preventive medicine could save. In fact, the National Center for Policy Analysis (they tout themselves as a “nonprofit, nonpartisan public policy research organization” cites several studies that show no improvement in health and claims:

But study after study has shown that preventive medicine adds to overall health care costs. The reason is fairly straightforward: Testing everyone costs a great deal of money, and the diseases being screened for are fairly rare. At best, the tests benefit only a few. And the savings generated by early detection of these few instances of disease are far outweighed by the costs of testing large numbers of people.

But Health Beat (I’ve been citing them a lot lately–there is just so much good stuff there) gives this anecdote from my home state of Minnesota:

This is also true (of preventive care benefits) in the U.S., in states like Minnesota, where there are many more primary care docs and many fewer specialists than in Southern California. After adjusting for differences in race, sex, age and overall health of the population, it turns out that care in Minnesota costs half as much–and outcomes, patient satisfaction and health are better. So it could happen here, without single-payer. We just need to limit the supply of specialists and make more primary care available and affordable.

So there is some decent debate to be had here.

But to my question: why hasn’t anyone seriously tried a preventive care model? This would be a lot of work (but a great experiment): a small to medium sized health care system (that utilizes a physician-as-employee model) would negotiate contracts with insurance companies to insure reimbursements do not dip below a pre-specified level during the duration of the experiment. But over (say) a two-year period the physicians and the hospital system would implement a preventive care strategy for all patients (while still providing traditional medical care). Obviously a great deal of planning and pre-implementation strategy making would have to occur.

My explanation is simple, but that’s the basic idea. Who would lose here? Insurance companies potentially (if preventive care adds a great deal of costs) but I would still argue it would be a very worth while experiment for them. The other problem I foresee is the fact that much preventive medicine doesn’t show its benefits immediately, it’s a long-run investment (which I am assuming is a large part of why there has been so little investment, businesses don’t see the payoff if an employee would only stay for five years).

There is some pretty important conversation to be had in regard to preventive care. I think we need to start thinking long-term, short-term fixes are exactly that. Could this experiment potentially work?

PS: This looks like an interesting for-profit foray into preventive medicine.