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January 31, 2018

Does preventive care save money? Nope—but it's still a bargain, Aaron Carroll argues

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on May 11, 2022.

    Many people believe that investing more money in preventive care can reduce overall health care spending by averting costly health problems down the road. Unfortunately, research suggests that just isn't true, Aaron Carroll writes for the New York Times' "The Upshot."

    Slide deck: The new reality of cost control

    Busting a common myth

    Carroll explains, "It's thought that too many people with chronic illnesses wait until they are truly ill before seeking care, often in [EDs], where it costs more." Therefore, he writes, common sense suggests "that treating diseases earlier, or screening for them before they become more serious, would wind up saving money in the long run."

    But research suggests that's not true, Carroll writes. He cites a study that found the Affordable Care Act's Medicaid expansion did not reduce ED use in expansion states as was expected, but actually increased such care. Research that looked at similar coverage expansion programs pre-ACA found similar results, Carroll writes.

    The reason, Carroll explains, is that people often choose to go to the ED "because it [is] more convenient" than making an appointment with a doctor. He writes, "When we decreased the cost for people to use that care, many used it more."


    Additionally, accountable care organizations (ACO) are founded in part on the belief that improving outpatient and preventive care will improve management of chronic conditions and ultimately decrease spending, Carroll writes. But according to a study published in Health Affairs, ACOs haven't driven savings.

    In fact, Carroll writes there is "little reason to believe" more preventive care will lead to major savings in health care spending. He cites a 2010 Health Affairs study that found that if patients achieved 90% compliance—an unrealistically high figure, Carroll notes—with 20 evidence-based preventive services, the health care system would have saved about $3.7 billion. That's about 0.2% of the total amount of personal health care spending in 2006.

    "A pittance," Carroll writes.  

    And preventive services don't save the country money as a whole either, according to a Congressional Budget Office report. The report estimated that reducing smoking through cigarette tax increases would likely decrease the number of smokers, which would decrease spending in the short term. But in the long term, these new non-smokers would live longer, which would lead to increased spending in other government programs, including health care, Carroll writes.

    But just because preventive care doesn't reduce health care or overall U.S. spending, doesn't mean that it's not a good investment, Carroll writes.

    "Prevention improves outcomes. It makes people healthier. It improves quality of life. It often does so for a very reasonable price," he writes. "There are many good arguments for increasing our focus on prevention. Almost all have to do with improving quality, though, not reducing spending."

    Carroll concludes, "We would do well to admit that and move forward. Sometimes good things cost money" (Carroll, "The Upshot," New York Times, 1/29).

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