Who Cares About Preventive Care? Who Should?
The role and scope of preventive care in our healthcare system has been a perennial issue for decades. Emily Willingham raises the issue and its role in healthcare reform and are larger healthcare system in light of a recent encounter on Facebook and more:
I received a Facebook invitation today to join in signing a petition to require insurance coverage for genetic testing for breast cancer. According to the petition, insurance companies might cover such testing if three people in a family have had breast cancer, but if "only" one person has, then no dice. I did some quick Mendelian math and cannot understand how three vs. one in terms of heritability makes a difference in individual risk. If your mother carries the BRCA allele, whether your sister or your aunt does has no influence on whether or not you do. If you inherit BRCA1 or BRCA2, your lifetime risk is up to 80%.
The invitation was timely because I'd already been mulling the relevance of prevention in the context of national health care. It is an enormous logical disconnect not to provide coverage for all standard preventive care, including vaccines (we once had insurance that did not cover vaccines). We've got another irrational disconnect on our hands if companies refuse to cover tests for at-risk people and introduce an irrelevant "three-person" rule into the heritability calculus, one that is not even within the National Cancer Institute's guidelines for "significant family history" of breast cancer. Surely the costs of such preventive interventions in at-risk populations are less than the costs of treating related acute or chronic diseases, even if broader screening across a population regardless of risk is not. That math can be worked out. A breast cancer allele, on the other hand, cannot.
The breast cancer petition is just one example. In our discussion of national health care, there ought to be a strong emphasis on coverage for standard preventive care. We should also consider encouraging covered individuals to meet benchmarks for regular checkups and immunizations (with the usual exceptions). Expenditure of tax dollars on a person's health could at least warrant emphasis on prevention adherence in maintaining good health. The cost savings in the long run are measurable in terms of economics. In terms of lives, they have no price.
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- by David F. on Jun 11, 2009 at 10:53 AM | link
Not all preventive services are created equal. Flu shots save lives AND money and should therefore cost recipients nothing at point of service - tho "covering" them with insurance doesn't make much sense. Few preventive services SAVE money even if theyre often a good value. Mammograms between 40 and 50 are questionable. Drawing such sweeping conclusions makes no more sense than generalizing about the value if all surgeries or all medications.
- by Susan on Jun 13, 2009 at 11:09 PM | link
I didn't mention mammograms in this particular post for several reasons, primarily related to what research has lately indicated regarding their risk-benefit outcomes.
Regarding the "should" for vaccine coverage--that may be a "should" but it is definitely not an "is," as our personal experience attests.
Regarding the assertion of "sweeping conclusion," I avoided exactly that by linking to a study that found that in many cases, prevention does not equal cost savings; however, many preventive approaches DO, and I linked to a study regarding those findings, as well. And another point I made was that sometimes, fiscal calculations should not be the only considerations.
My purpose in providing these links was for readers to see that not all preventive services are created equal. This blog post was not an across-the-board call for massive coverage of all preventive care for all people; as I note, many tests are best in terms of specificity if they are done only in at-risk populations, rather than across the general population. The main message of this post is that standard preventive care (vaccines, BP checks, annual checkups) cannot be neglected in the upcoming national healthcare discussion, including a strong emphasis, as I wrote, on encouraging anyone receiving subsidized coverage to observe preventive care benchmarks. And better, research-based algorithms are needed and should be required for insurance companies deciding which preventive testing to cover in at-risk populations.
For a more in-depth comparison and evaluation than can be provided in a blog post, I refer you to the most recent issue of Time Magazine, which has made inclusion of prevention in the national healthcare discussion its cover story.
- by Emily Willingham on Jun 15, 2009 at 4:25 PM | link
Preventative medicine is where most of the money should be spend because of an array of reasons. Keeping & funding preventative care will in the long run proof to be less expensive for the individuals, the healthcare system and the insurances. Prevetative care assists with the catch early thought process that has and will save many lives in the time. We usually wait till something is worng before we see the doctors and for most that is too late. Education should be another form of preventative care. Educate people to take better care of their bodies and make healthier, educated choices.
Thanks.
- by RM - ProActive News Room on Aug 17, 2009 at 1:58 PM | link