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The Price of Preventive Health Care (Part 1)

Posted Apr 26 2010 10:47am

They say an ounce of prevention is worth a pound of cure, but is that still true in today’s money? Recently I had an illuminating conversation with a patient that got me thinking about how I may try to answer this question. This is the first in a short series on the price of preventive health care.

Mr. GR, as I will call him, had recently turned 60 years young. Though he had been in good health, the notion that he was “getting old” was beginning to settle in, and so Mr. GR came to me interested in finding out what more he could do to stay healthy. In discussing various preventive health measures, I pointed out that he would benefit from getting vaccinated against shingles. Shingles, I explained, is a painful skin condition that in 1 in every 3 people can expect to develop in their lifetime. For most people an episode of shingles lasts a few weeks, but in 1 in every 5 affected individuals the condition becomes permanent and debilitating (called post-herpetic neuralgia). The shingles vaccine can reduce the risk of shingles by half and of post-herpetic neuralgia by two-thirds, which is why the Centers for Disease Control and Prevention (CDC) recommends vaccination for everyone ages 60 and older.

After our discussion, Mr. GR was convinced the merits of the shingle vaccine were worth the discomfort and small risks of vaccination. But then he found out his insurance company didn’t cover the vaccine. Mr. GR immediately changed his mind: “If it’s not covered by insurance, I don’t want it.”

This is an all too common scenario. Patients don’t want health care that isn’t paid for by insurers. It is a sentiment shared by many of my patients and one I am empathetic toward. If not CDC recommended preventive health measures, what exactly is health insurance coverage for? At the same time, another part of me believes that while we should be indignant towards our health insurance companies for the decisions they make, this alone should not preclude us from doing the right thing for our health. As individuals we spend money on many things, not all of which is essential, so why the reluctance to spend money for better health?

In this case, the shingles vaccine costed a whopping $844. No small change, to be sure, for somebody to pay for in one setting. But what if we thought about it another way? What if instead of considering the vaccine as a one-time cost we thought of it as a daily expense — the cost per day of reducing my risk of a painful, potentially disabling medical condition? After all, the benefits of vaccination accrue daily so why not consider the costs daily. If we assume that Mr. GR lives until age 76 (the life-expectancy for men in the United States) the cost of the shingles vaccine amounts to $52.75/year or 14 cents per day. (For those of you are into finance, a more appropriate method of estimation would be to use discounting. After all, a dollar today is worth more than a dollar tomorrow. Assuming a 5 percent discount rate, $844 today is equivalent to spending 21 cents per day for 16 years.*)

Explained this way Mr. GR had a real choice on his hands – were the health benefits of vaccination worth more than 14 cents per day? To my delight, Mr. GR changed his mind. He still wasn’t happy about dishing out over $800 for something that he felt his health insurance company should cover but the simple back-of-the-envelope math we did helped him better understand the decision he faced.

In the end, whether or not we like to consider it this way, health care decisions are also financial decisions. We make plenty of financial decisions that pertain to our health: whether we buy organic food, get membership at a gym, or drive a car with more safety features. I certainly won’t argue against health insurance companies’ providing better coverage for preventive health care or against the government increasing programs to support prevention. But while we wait for change to come, we cannot afford to put our health on hold.

At less than a quarter a day the shingles vaccine is a downright bargain. And having done similar calculations for other areas of prevention so are many other established preventive health services. So go on, treat yourself to better health.

- Shantanu Nundy, M.D.

* Calculation courtesy of my dad, Rajiv Nundy, an actuary for the Asian Development Bank.

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