It seems like a no-brainer.
Since about 75 percent of healthcare spending in the United States is for largely preventable chronic illnesses such as Type 2 diabetes and heart disease, providing more preventive care should cut costs.
In a report released on Tuesday, the non-profit Trust for America’s Health outlined a plan “to move from sick care to health care” by putting more resources into preventing chronic disease rather than treating it, as the current system does. There is a strong humanitarian justification for prevention, argued Trust Executive Director Jeffrey Levi in an interview, since it reduces human suffering.
But the report also makes an economic argument for preventive care, highlighting the possibility of reducing healthcare spending — which in 2011 reached $2.7 trillion, just shy of 18 percent of gross domestic product — by billions of dollars. And that has health economists shaking their heads.
“Preventive care is more about the right thing to do” because it spares people the misery of illness, said economist Austin Frakt of Boston University. “But it’s not plausible to think you can cut healthcare spending through preventive care. This is widely misunderstood.”
A 2010 study in the journal Health Affairs, for instance, calculated that if 90 percent of the U.S. population used proven preventive services, more than do now, it would save only 0.2 percent of healthcare spending.
Some disease-prevention programs do produce net savings. Childhood immunizations, and probably some adult immunizations (such as for pneumonia and the flu), are cost-saving, found a 2009 analysis for the Robert Wood Johnson Foundation. The vaccines are cheap, and large swaths of the population are vulnerable to the diseases they prevent. The cost of providing them to everyone is less than that of treating the illnesses they prevent.
Counseling adults about using baby aspirin to prevent cardiovascular disease also produces net savings. The counseling is inexpensive, the aspirin even cheaper and the costs of heart disease, which strikes one in three U.S. adults, are enormous. Screening pregnant women for HIV produces net savings, too.