Volume 13, Number 7
The current healthcare crisis/debate in the United States is very important and polarizing, as the implications for health, lives, costs, healthcare organizations and other entities are far-reaching. The current debate, and the main focus of health insurance, is about how to pay for care of the sick/injured (much of which is the management of chronic illness). A very minor component of the debate is prevention, such as to what extent prevention-related activities (e.g., screenings) will be mandated and/or included in health insurance plans.
Prevention is a major consideration when health economics are more broadly considered, particularly with respect to investments in public health. Public health focuses on protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention, and detection and control of infectious diseases.
Consider some monetary figures as they reflect the minor emphasis given to public health in the United States. Public health spending in 2014 amounted to $255 per person, compared to $8500 per person for total health-related spending. More than 80% of healthcare spending goes for the treatment of chronic diseases, and roughly half of all adults have at least one chronic disease. However, the entire budget for chronic disease prevention at the Centers for Disease Control and Prevention (CDC), the primary public health agency in the United States, amounts to $4 per person per year. Less than 3% of the over $3 trillion spent in the United States on health is invested in prevention. And for the first time since 1993, life expectancy in the United States declined last year.
Evidence-based public health initiatives and prevention efforts are consistently found to be cost-effective. For every $1 spent on evidence-based community prevention programs focused on increasing physical activity, improving nutrition, and decreasing tobacco use, the average healthcare savings is over $5. School-based substance misuse prevention efforts have shown returns of $4 to $34 for each $1 spent, a somberly important consideration given that one of the reasons for the current decline in life expectancy is the epidemic of deaths from opioid overdoses.
Among the many reasons why only 3% of health-related spending is devoted to prevention is that the results of effective prevention are non-events, that is, something we can’t see. One can tell a compelling and emotional story about a relative who had a severe heart attack and survived because of advanced medical care, but there are no such compelling tales about a relative who didn’t have a heart attack because of a healthy diet and regular physical activity. It’s more difficult to be motivated to pay for something we can’t see (no heart attack) than something we can see (lifesaving medical interventions for the heart attack victim). Relatedly, it can be difficult for a person who currently has good health to be motivated to buy health insurance, because there is no event or condition to serve as an obvious reason for needing health insurance. While the cost-effectiveness of prevention efforts is impressive, it’s a challenge to motivate spending on prevention when the justification is based upon data about events than never transpire.
Prevention does cost money. The $4 per person that the CDC spends on chronic disease prevention activities adds up to nearly $1.3 billion dollars. Of course, public health and disease prevention initiatives won’t and cannot prevent all chronic disease, but even a $10 per person investment in the aforementioned evidence-based community prevention programs could save an estimated $16 billion dollars. When one does the balance sheet, this article could more accurately be titled, “Lack of Prevention Costs a Lot!”
Paul J. Hershberger, Ph. D.
… is a clinical health psychologist. He is Professor and Director of the Division of Behavioral Health, Department of Family Medicine, Wright State University Boonshoft School of Medicine.
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