Prevention

We've mentioned soaring U.S. health costs many times before, but a recent Commonwealth Fund report puts into perspective '"what we pay for" versus "what we get" from our health system. In comparison to other industrialized nations, according to The Washington Post, the U.S. is one of the top spenders on health care -- $2.4 trillion annually -- but we rank near the bottom in preventable deaths.

The report, Reducing Preventable Deaths Through Improved Health System Performance, found the US had the highest rate of preventable deaths, with 110 out of 100,000 dying in 2002-2003. For example, controlling for age and whether death is preventable from certain conditions, the study found women under the age 75 died from health care-amenable causes at a rate of 96.41 per 100,000 in the U.S., versus 68.15 in Canada and 57.40 in France. Though all countries made progress in lowering rates of preventable deaths between 1997 to 1998 and 2002 to 2003, the United States made the least progress, dropping from 15th overall in preventable mortality to 19th, said a similar study in Health Affairs.

A growing number of Americans rely on federally qualified health centers for care, reports The Wall Street Journal. Last year, community health centers, as well as migrant and homeless health centers, served approximately 18 million people. That number is expected to hit 20 million this year, according to the WSJ and the National Association of Community Health Centers.

As you know, there's been a ton of argument about whether prevention saves money -- and one of the issues has been how narrowly we define "prevention," whether we treat it as a synonym for "screening for early detection of disease" or whether it's something bigger.

We all know you can earn rewards for frequent flying. But what about for routine trips to your doctor?

Emphasizing primary care and preventive services is a key goal of health reform and many contend the savings from such programs can help finance a health care overhaul (and make us a healthier country). Yet, the details of how these savings might be realized are less clear.

I was about to recommend Minna Jung's thoughts on preventive care at the RWJF's Users Guide to the Health Reform Galaxy blog, when I realized she ended her post by recommending mine....

I was at a conference yesterday and couldn't post about President Obama's nomination of Dr. Regina Benjamin to be surgeon general. Today I'm reposting what I wrote last September when she won a MacArthur "genius" grant,"

I met Dr. Regina Benjamin only once but she's not easy to forget. She took the time to travel to Missisippi in the spring of 2007, about 18 months after Hurricane Katrina, to talk to a small group of health care journalists. We weren't writing about her that day, we were just learning from her, and she was fine with that. Dr. Benjamin is a family physician in the tiny shrimping community of Bayou La Batre in southernmost Alabama. It is racially and ethnically mixed, including an influx of Vietnamese who were drawn to its shrimping fleet, probably the only thing in the fictional home of Forest Gump that was familiar to them...

Business Week takes a look at the medical home model, and finds that, lo and behold, primary care docs can provide high quality coordinated care and boost their income to boot.

At a meeting we attended about health reform the other day, one side of the room was saying of course prevention saves money and the other side was saying with equal certitude that of course prevention doesn't save money. (Forget the irony that we were having this discussion over a pizza lunch. With no salad.) A lot of other people are having this debate, and we attended a helpful panel discussion recently sponsored the Alliance for Health Reform.

We'll grant that if you look, you can find good solid economic arguments that prevention (depending on how it's defined, but more on that in a minute) doesn't save money. At least it doesn't save money in the five- or 10-year budget windows that Washington is used to talking about (and which legislation must be measured against). Economist Louise Russell has been writing about this for years, and her widely cited article earlier this year in Health Affairs (and a shorter version on the Hastings Center blog) makes that argument. Note she is not saying prevention isn't a good thing; she's saying it isn't a "money-saver," strictly defined.

But you can find good solid arguments, too, that prevention and wellness does save money, and can save it quickly. A number of major corporations—Intel, Pitney Bowes, IBM, to name a few—report a high return on investment within a few years (sometimes sooner). They have taken a variety of steps—incentives for diet and exercise, tobacco-counseling, health screenings, no-copay screenings—that are producing a healthier workforce at lower cost.

As they say on Facebook... It's complicated. Let's break it down.

The New York Times Economix blog, following up on last fall's "Ideal Stimulus Package" grab bag of ideas, invited a whole bunch of consumers, patients, workers, doctors, businesses, insurance companies, tax and public finance experts to opine about what health care reform should look like (not sure if they asked the trickier question of how to pay for it). First batch of responses is up now. Check back later for more.

It took more than a decade but the Senate has passed sweeping legislation to give the FDA authority to regulate nicotine and tobacco advertising. Stopping tobacco use is the mother of all preventive health measures. And prevention is a big missing link in our current health care system—you know, the system we want to change.