Prevention Matters

In 2009, health spending in America as a percentage of Gross Domestic Product (GDP) rose from 16.2% to 17.3%, according to a new paper in Health Affairs. That's the largest one-year increase since such 1960, when such statistics began to be closely tracked. The percentage is still very much higher than that of any industrialized country.

Total health spending in the U.S. amounted $2.472 trillion last year (or, as WSJ's Jacob Goldstein notes, at a rate of $282 million a hour). Health-care prices rose by 3.2% in 2009, significantly above the overall inflation rate, while utiilization of health care rose by 1.5%.

The national economic burden of diabetes has reached $218 billion, according to a study in Health Affairs. The authors have created a Cost of Diabetes Model that combines information from peer-reviewed literature, analyses of national survey and medical claims databases, and government statistics.

For 2007, they calculated that the national economic burden of diabetes and pre-diabetes was a staggering $218 billion, which included $153 billion in medical costs and $65 billion in reduced productivity.  This translated to approximately $700 per person. The $65 billion estimated productivity loss associated with diabetes came from higher levels of absenteeism, working at less than capacity, and early mortality.

“The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life…underscore[ing] the urgency to better understand the cost-mitigation potential of prevention and treatment strategies,” the authors wrote.  They said the study shows that lifestyle changes (diet and exercise) can help delay or prevent the onset of diabetes.

According to the American Diabetes Association, nearly 17.5 million people were diagnosed with that disease in 2007; another 6.3 million adults are living with undiagnosed diabetes.

A Health Affairs article reviews the evidence on workplace wellness programs and concludes that the medical savings outweigh the costs for employers.

The authors conducted a critical review of more than 100 existing peer-reviewed analyses of employee wellness programs, many of which use health risk assessments and focus on obesity and smoking, the top two causes of preventable death in the United States. They found that these initiatives save employers money both through reduced health costs for their employees and reduced absenteeism.  For every dollar spent on wellness programs, about $3.27 was saved in medical costs and $2.37 was saved in reduced workplace absenteeism.

A new poll published in Health Affairs Blog indicates the American public’s support for the major health legislation being debated in recent weeks has fallen to 27%, with 59% opposed. Yet it suggests that incoporating just one proposed amendment - tort reform - raises support for the bill to “too close to call” (44% for, 46% against). The second biggest boost would come from eliminating the individual mandate, and the third from adding a public option. Several combinations of two amendments would yield plurality or majority support.

The Health Affairs website offers a study that explores alternative methods of projecting federal health care spending that incorporates actual clinical information.

The study was prepared by Elbert Huang and Anirban Basu, assistant professors of medicine at the University of Chicago School of Medicine; Michael O'Grady, senior fellow at National Opinion Research Center at the University of Chicago; and James Capretta, a principal of Civic Enterprises LLC in Washington, D.C.

"Current federal cost projection methods are constrained by ten-year cost estimates, which capture increases in near-term intervention costs but not changes in long-term costs," they write. "Current methods also cannot easily capture the cost implications of changes in disease progression. Type 2 diabetes is a prime example of a chronic illness with long-term health and cost consequences."

“I’m trying to show (the Congressional Budget Office) that there are other ways to do this, as we face these new challenges from the epidemic of chronic illness,” O'Grady told the Washington Post. “They’re used to thinking like economists. And their friends at Health and Human Services are used to thinking like actuaries. But there’s this third way, which is epidemiological, which shows us how a disease progresses over time.”

Disease prevention and health promotion has taken some hits recently on the grounds that it doesn't save money. Health Affairs, the Congressional Budget Office and The Washington Post have all published studies or commentary contending that any savings realized through prevention is offset by the additional expenses incurred when people live longer.

Concerned that prevention could be dismissed as a important part of health reform efforts in Congress, members of the prevention community began pushing back recently. Partnership for Prevention commissioned a white paper from some of the nation's leading authorities on prevention and public health who made the economic case for prevention. One of the authors of that paper, Steven H. Woolf, MD, MPH, of Virginia Commonwealth University, then summarized that paper in a commentary that appeared in the Feb. 4 issue of JAMA. Partnership and the WellPoint Foundation then held congressional briefings on Capitol Hill on Feb. 4 in which Woolf was joined by Partnership Interim President Corinne G. Husten and Marc Manley, MD, Medical Director and Vice President at Blue Cross/Blue Shield of Minnesota.

Their conclusions: some preventive measures save money and some don't, but many provide enormous value in terms of health benefits per dollar spent. It is this value - translated into the ability to stem the increase in chronic diseases that are driving health costs upward - that need to be more closely considered as we seek to reform the health care system. And that should apply to medical treatments as well.

The briefing was recorded and can be watched online by clicking the TV set pictured on the right.

The National Health Statistics Group reports that health care spending in 2007 grew 6.1%. The overall response to that news has been an interesting mix - one that gives you the impression that while the oncoming train is still headed for your car stuck on the crossing, at least it's slowed down a bit.

Several media reports focused on the fact that it was the lowest level of growth in health care spending in nine years. But, as Forbes noted, since the total economy grew by only 2.3% in 2007, the 6.1% hike in health care costs still means everyone’s losing ground.

Drug costs grew by only 5%, as a number of low-priced generics came on the market. But hospital and doctor spending grew 7.3% and 6.5%, respectively, and health insurance premiums grew by 6 percent.

Meanwhile, Health Affairs published a study that shows out-of-pocket medical expenses in the U.S. have grown by 40% over the last decade. Study author Kathy Paetz says it's due largely to the fact that middle-aged Americans today are 10 percent more likely to suffer from more than one chronic disease. Prevention, anyone?