INVESTING HEAVILY IN PREVENTION MEASURES MAY NOT REDUCE HEALTHCARE COSTS, RESEARCH SUGGESTS.

Even though past efforts have yielded "little success," lawmakers on both sides of the aisle are fixated on "one idea" when it comes to reigning in the healthcare system's spiraling costs: "A bigger government role in disease prevention." This is the conventional Washington wisdom. “The health-care system is tilted toward a disease system rather than a wellness system," said Health and Human Services Secretary Kathleen Sebelius in an interview.

But what if they built this big edifice of preventive care and no one came?

Many previous government prevention efforts aimed at costly chronic diseases have had little success in reducing illness or costs. Medicare has conducted seven pilot programs in the past decade testing the theory on some of the most costly chronic diseases. Each showed little if any cost savings or measurable improvement in patients' health.

The largest experiment, the Medicare Health Support program, started in 2005 and eventually included about 200,000 patients. Groups were assigned to companies that specialize in helping people with chronic health conditions lower their medical costs and keep from getting sicker. Most of the patients had diabetes or congestive heart failure.

Nurses contacted the patients to make sure they were following doctors' instructions to take medication and reduce sodium intake. They also mailed patients packets about their diseases and directed them toward community health classes.

Overall, the program didn't reduce the group's rate of acute-care hospitalizations, hospital readmissions, emergency-room visits or death. It also didn't meet its goal of lowering patients' Medicare payments in an amount equal to the cost of the prevention services. The company that achieved the highest cost savings recouped only 26% of the fees spent on the program through lower Medicare spending.

There are studies which corroborate the "benefits of a healthy lifestyle." But the "problem is that when testing becomes too widespread, or heavy investments are made in monitoring people with chronic diseases, the rewards often fail to match the costs." This was exemplified in a 2008 NEJM report "which examined 279 spending ratios in published studies of health-oriented prevention measures, and another 1,221 on treatments for people who were already sick and "concluded that most preventive measures reviewed didn't save money. For instance, screening all 65-year-olds for diabetes would cost an extra $590,000 for every healthy year of life it adds over just screening people that age with high blood pressure."

To cap it all off the Congressional Budget Office, in its report, concluded that greater use of preventive care would at best generate modest reductions in costs over 10 years, and might even result in increases.

One reason cost savings are hard to achieve, is that much of the money spent on disease prevention goes for people who aren't going to get sick anyway. Also, people have trouble making difficult lifestyle changes, such as taking up regular exercise or eating healthier food.

CQ Today reports that preventive care's financial benefits is a "myth.” Although such initiatives would, in many cases, result in better health, it is less clear that they would reduce total spending for healthcare. ... Many other studies that have examined the impact of such initiatives do not indicate net savings."

So much for the conventional wisdom and saving money for Health care reform by increasing preventive care.

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