February 14, 2008
Arnold Kling
'rdan' quotes a study in the New England Journal of Medicine.
Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical. Such analysis could identify not only cost-saving preventive measures but also preventive measures that deliver substantial health benefits relative to their net costs; this analysis could also identify treatments that are cost-saving or highly efficient (i.e., cost-effective).
In addition to determining which preventive measures and treatments are most efficient, it will be necessary to identify those that are not yet fully deployed and those that could serve a large population and bring about substantial aggregate improvements in health at an acceptable cost. Findings that some cost-saving or highly efficient measures are underused would indicate that current practice is inconsistent with the efficient delivery of health care. Other services might be identified as overused, and such findings would underscore the importance of fashioning policies that provide incentives to shift practice toward more cost-effective delivery of health care.
Some people want to believe that preventive medicine is the solution to rising health care costs. Instead, these authors recommend careful cost-benefit analysis of all forms of health care. I agree.
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This speaks for itself.
Nine Secrets Health Insurers Don’t Want You to Know
To get tested, talk up your symptoms.
Your insurer doesn’t want to pay for a colonoscopy if it’s not necessary. But if your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, here’s how to get one covered: Mention to your doctor that you’ve had some blood in your stool and a lot of gas lately—or simply that your bowel habits have changed. Your plan has to pay for the test if you have gastro complaints, health experts say. (Only 21 states require insurers to cover colonoscopies for general screening.)
Many physicians have known about the limited value of preventive care for years. The problem is that medical professional societies, the Centers for Disease Control and Prevention, the various groups within the National Institutes of Health, and private foundations such as the American Cancer Society all recommend many preventive health measures. Physicians follow too many recommendations that have low cost/benefit ratios. This is due to three factors: ignorance (failure to read the actual studies), greed (one can make much money on the initial preventive care tests and the follow-up visits when results aren't perfectly normal), and fear (of missing a bad disease and getting sued).
The only group whose recommendations I consistently trust is the U. S. Preventive Services Task Force. http://www.ahrq.gov/clinic/uspstfix.htm This group only recommends preventive care that has objective evidence of significant benefit at reasonable cost. A good example is screening for prostate cancer.
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE).
In contrast, the American Urological Association http://www.auanet.org/index.cfm recommends screening with PSA testing and digital rectal examination, and recommends prostate biopsy if PSA is even slightly elevated. Pathologists get lots of non-cancerous prostate biopsies due to this guideline.
