Is Preventive Medical Care Worth the Cost?

Article excerpt

There is perhaps no issue in medicine that appears to have been so definitively answered as has the need for preventive medicine. After all, the money and life-saving potential of preventive care is as old as the hills. Nearly everyone grew up learning cliches such as "a stitch in time saves nine" and "an ounce of prevention is worth a pound of cure."

Currently, medical professionals advise that Americans undergo an entire battery of preventive screening tests and exams. The American Medical Association, for example, recommends physicals every one to five years for people between ages 30 and 50, and every one to two years thereafter. Regular cholesterol tests are encouraged. Colon exams should be conducted every year for people over age 30. Screening tests for cervical cancer are recommended every one-to-three years for women over age 30.

All this testing, of course, is designed to catch health problems early, before they have a chance to manifest themselves as harmful diseases. The benefits of preventive medical care, according to the medical and insurance industries, are not only reduced cost, but prolonged life.

An entire industry has grown up around the goal of prevention. Managed care companies often refer to themselves as "wellness" plans. By keeping enrollees well--through preventive screening tests, nutrition counseling, and the like--these companies say they can save money by preventing the need for costly treatments.

In the debate over health care reform last year, much was said about the need to offer every American health insurance that provided generous coverage for preventive care. The savings from preventing diseases could easily pay for the expanded coverage, or so the argument went. President Clinton claimed that "any family doctor will tell you that people will stay healthier and long-term costs of the health system will be lower if we have comprehensive preventive services." The apparent need for preventive care continues to permeate the current health care reform debate.

Like so many other bits of conventional wisdom, the facts of the matter are far less clear. In fact, studies show that, in many cases, prevnetive medical care not only doesn't save money, it may do little to prolong life.

Care must be taken to distinguish between "prevention," broadly understood, and the more narrowly defined area of "preventive medical care." Anything that can prevent a disease can be labeled prevention. Eating a proper diet, getting adequate exercise, avoiding being overweight, not smoking, drinking in moderation, proper sanitation, and immunication are all examples of prevention. The medical literature has conclusively demonstrated that many diseases and premature deaths are avoidable simply by choosing healthy eating and living habits. Two recent studies published in the Journal of the American Medical Association, for example, demonstrate that exercise enhances longevity. One followed more than 17,000 people over a span of more than 20 years, and found a strong correlation between vigorous exercise and increased life span.

In addition, public health efforts to do such things as clean up the water and improve sanitation have also proved to be a tremendous boon to disease prevention and longevity. In fact, according to some health experts, most of the increases in life expectancy resulted not from advances in medicine, but from improvements in public health. "Most people would agree that medical care is not the most important factor in determining health," says Jack Hadley, co-director of the Washington-based Center for Health Policy Studies.

Similarly, immunization has greatly reduced the likelihood of getting a variety of previously devastating diseases, such as polio, diphtheria, measles, and so on.

Preventive medical care, on the other hand, is a much more narrowly defined concept. It includes regular exams and screening tests designed to catch a disease or a health problem before it has a chance to produce any symptoms. …