The Best Thing I’ve Read Recently on Preventive Medicine
More than any other area of medical care, “preventive medicine” attracts by far the highest ratio of uniformed nonsensical rhetoric to actual fact. Al Lewis, at The Health Care Blog, sets the record straight on Asthma:
The average cost of an [asthma] attack requiring an ER visit or inpatient stay is about $2000. The average cost to fill a prescription to prevent or recover from an asthma attack is about $100. It turns out that asthma attacks serious enough to send someone to the ER or hospital are rare indeed. In the commercially insured population, these attacks happen only about 3-4 times a year for every thousand people…a health plan would pay, on average, anywhere from $6000 to $13,300 to prescribe enough incremental drugs to enough incremental people to prevent a $2000 attack…
Assume, very conservatively, that low-risk patients have a risk of attack which is half that of the average patient. This means that putting most low-risk patients on drugs costs $12,000 to $26,600 for every $2000 attack prevented…
It’s not just that this is a wasteful negative return on investment. This is where the catchy title comes in: It’s also that there are known short-term side effects to these drugs.
Entire post is worth reading.
This example uses a condition that people have — asthma. It illustrates that some measures we would think should save money in fact don’t. The primary point is even more pronounced when you look at conditions people don’t have but can be screened for. If everybody takes advantage of all the preventive medical services available, some would have a serious condition caught early. Many more would be needlessly forced to undergo tests and — in some cases — unnecessary treatments due to a false positive. All things considered, the total cost of medical care would be higher — not lower.
Prevention is something people invest in for peace of mind. It is not something insurers and government should invest in hoping to generate a positive financial return. I’m not advocating the elimination of preventive screenings. I’m merely explaining that policymakers understand what preventive medical screenings can (and cannot) do.
Smartest? More like the stupidest
This is a result of the prescribing habits of individual physicians. Unless you establish breath panels, it will remain that way. The other issue is that unlike the usual population screening, this isn’t some general, “low risk” population. It’s a population that’s already at risk, and identifying beforehand the asthma specific attack risk isn’t possible. Lastly, the asthma attacks are life threating events. It’s a pretty clear wrongful death if it’s caused by not paying for that 100 dollar prescription.
Exactly why healthcare continues to skyrocket out of control. This prevailing mentality of security in over-prescription.
I think part of the problem (and I can’t speak for asthma specifically, because I’m not a doctor and I don’t have it) is that doctors formerly had very few instruments at their disposal. As a result, any care offered was likely necessary. We still have this mentality that we need to do absolutely everything available for everyone.Plus the cost isn’t zero.
For example, I have a heart murmur. I was diagnosed as a child and have been asymptomatic my entire life. I used to take prophylactic antibiotics before I went to the dentist to mitigate cardiac infection risk. Recently revised guidelines indicate that I was never in the appropriate population for this kind of care.I shudder to think of how long I took unpleasantly high doses of antibiotics for almost no benefit as well as had office visits and other fees to have them prescribed every time I needed a cleaning. In my case, I was receiving prevention that is almost universally acknowledged as doing me no good. I think that’s what this post means to address.
Over-prescribing a patient is just as bad as under-prescribing them. Whether is asthma or any other type of condition, this just represents a loss of revenue, a waste of resources and a threat to the lives of those patients involved. Some people call it preventive measures, other people call it a waste of health care money, resources and drugs. Physicians treat prescription drugs like candy, they just give it away not cosidering the cost this represents and, most importantly, the effects they may have on the people that take them.
I agree with Jennifer. We healthcare officials need to to start being more efficient with their resources.
very interesting
Quality of life would be pretty bad with asthma control drugs. The sole cost is not just the ER visit.
Can’t people die from asthma attacks? What is the economic cost there?
My problem with this whole line of reasoning is that it completely takes what the customer wants out of the picture. I’m a wealthy (compared to the rest of the world) first world citizen. I’ve paid for my food, my water, my shelter, my transport, clothing, etc etc. And I still have money to spare. I’d rather have better health than another pair of shoes, and wish to spend my excess money on that.
The actual problem is that we have a one size fits all approach to insurance in this country now. I should have the freedom to seek out insurance coverage that would cover my hypothetical asthma needs if I want to, and pay a premium for it. Someone else should have the freedom to seek out insurance coverage that doesn’t cover asthma needs, save money, but suffer a lower quality of life because of it. The consumer should be allowed a choice.
When we effectively homogenize insurance choice through massive regulation and coverage mandates, then, to save money (aka ration by access) we have bureaucratic advisory boards start peeling away recommendations for coverages, you take some of my freedom away, and I dislike it. There is not a good free private market out there for medical care. Everything ultimately ends up dictated by the government through coverage mandates and medicare.
+1 Chris