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Prevention Pros and Cons

Posted Aug 23 2009 10:56pm

Once again, I'd like to thank all of you regular contributors that keep this blog going despite my occasional respite. Of all the health care blogs and even non-health care blogs I've visited, this one has the most ongoing contributions. Kudos to all of you for the great input.

The readership continues to grow and I'll be looking at additional ways of bringing more opinion to us. Welcome to Dazzo and a welcome back to Lurker. We all look forward to hearing more from you as well as from our very informed regulars.

Recently I've been struck by the emotional and divided response to President Obama's call for health care refrom in the US. Various individuals and groups on both sides of the discussion have been vilified from time to time and it just doesn't seem like a very tolerant way to go about debating or advancing improvements in health care.

Can't we just get along and allow individuals who want to spend on their own health care to do so whether through health savings accounts, tax free savings accounts, or transgenerational insurance or other?

Can't we just agree to disagree and then let individuals find what works best for them? We've done this in many areas. Why not in health care?

One of the biggest criticisms of Canadian health care recently is that there isn't enough government money spent on prevention and wellness--we are disease oriented in terms of providing health care. That's a fair criticism but look a bit deeper and it may be surprising to find that prevention won't save health care dollars which is why there are discussions about health care reform in the first place. If there were sufficient funds to cover everything for everybody, there would be no debate or even need for reform.

As much as there are many people devoting much time and energy to the promotion of better health and health outcomes, we need to be honest about the cost of such programs. It seems that the underlying premise is that more prevention will save health care dollars. But such may not be the case.

We should first mention that there is a difference between individuals being in charge of their own prevention and taking responsibility for their actions or inactions versus  government funded health prevention programs that take into consideration mass screening, large amounts of pharmaceutical use, and a large scale push toward incentives and pay for performance for providers.

As much as prevention would seem to offer up cost savings, the potential outcome of more government organized screenings and primary care prevention at the provider level (and here  I  make the distinction that the latter should be seen as separate from public health type policies that allow for clean water, improved sanitary conditions and clean air and environmental awareness) to cost more, not less, is quite real.

I will post the link to the Congressional Budget Office and its information on overall cost savings on prevention in health care and also the link to the letter that is mentioned.

Now some of you reading will think that I am a real dope and that I don't believe in prevention. That is not the case. I do believe in prevention. It's just that I don't believe prevention will save the health care system in Canada any money. It will cost MORE. Let me repeat that. Prevention will cost MORE.

On an individual level, better prevention of all kinds will provide improved quality of life. However, costs of health care prevention measures must be weighed against the need for improved education for Canadians as well as the need for more social programs such as adequate housing for dependent individuals amongst other important and urgently needed public health improvements.

The idea that more prevention will keep down health care costs is just wrong. It certainly deserves its place but preventative health care needs to be seen for what it individual decision requiring individual responsibility.

Thanks for reading and for your most enlightening contributions as always. I am most grateful for your support.




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