Disease Prevention is no Cure

August 14th, 2009 | Sources: Wall Street Journal


Seems like just about the only thing folks inside the Beltway can agree on these days is that the US government ought to invest in disease prevention. It’s cheaper to keep people healthy than to treat them after they become sick, right?

igotanideaWell, maybe.

The Wall Street Journal is reporting that some government-led prevention efforts have worked, while others have been costly failures.

The WSJ cites a study on the matter appearing in last year’s NEJM for example, which reviewed 279 prevention-oriented government initiatives and found a mixed bag.

The NEJM authors cite a program to increase colonoscopy rates in men in their early 60s as one that saved lives and money, but pan another that screened people for diabetes in addition to high blood pressure. That one wound up costing $590,000 for every healthy year of life added.

Meanwhile according to the WSJ, Medicare has conducted 7 pilots of disease management programs in the last decade, and not one of them showed cost savings or improvements in health status.

The largest such study was the Medicare Health Support program, which began in 2005 and covered 200,000 patients. In that study, participants with diabetes and CHF were assigned to companies that were supposed to help them improve their health while reducing medical costs.

Nurses from these companies contacted patients relentlessly to assure treatment plans were implemented. They shipped educational materials and shepherded patients to health promotion classes.

The initiative had no impact on hospitalization rates, readmission rates, ER visits or mortality, nor did it cut Medicare payments by an amount equal to the costs of the services themselves, which amounted to between $67-118 per month.

Disease management programs like these are “not going to cut costs,” Louise Russell, a professor at Rutgers University told the Wall Street Journal. “We already do a lot more prevention than other countries (and)…we are not healthier.”


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