Prevention Matters

Mexican police dealing with the swine flu epidemic there have arrested 13 individuals accused of selling surgical masks on the street. This led Health Economist blogger Jason Shafrin to examine the ethics associated with providing free surgical masks.

If the government stayed out of the picture and allowed private enterprise to address the surgical mask situation during an epidemic, "manufacturers of surgical masks would receive the same amount of money, but instead of getting paid by the government, they would be paid by firms," Shafrin says. "Firms would be the winners in that they could resale the masks at a profit. Wealthy and middle class households would be able to purchase the masks and poor families would not."

Another argument for free distribution of surgical masks is to prevent corruption, Shafrin says. "If individuals can sell surgical masks at a profit, government workers will have an incentive to give away surgical masks to their friends," he says. "Their friends can collect rents from their receipt of a large quantity of free masks."

Healthcare Economist took a look at Partnership for Prevention's recent recommendations to Congress and registered some concerns. In short, they think we're creating a new universal prevention care program that invites cost-shifting, coverage creep and carve-outs. He also says effective preventive care would increase health care costs by increasing longevity and improving the quality of life, and smacks of paternalism.

Partnership Interim President Corinne Husten today sent the following response:

"Thanks for calling attention to Partnership for Prevention’s recent recommendations on prevention as part of the health reform debate. We’re glad you recognize some benefits, but I think a careful reading of our proposals will dispel some of the concerns you’ve raised.

"For one thing, we aren’t “introducing ‘federally funded insurance programs,’” but merely proposing changes in programs that are already established (e.g. Medicare, Medicaid, VA, etc.). We simply propose eliminating cost-sharing requirements (which research shows is a barrier) for high-value clinical prevention services in these existing programs. And because this proposal isn’t for new insurance programs, that should negate the concerns about coverage creep, carve-outs and cost-shifting.

"Secondly, we don’t claim our proposals are cost-saving, but they are cost-effective. There’s an important difference between the two. Health care costs money, whether it’s from a surgical procedure, a prescription drug, or from a preventive service. Cost-effective measures provide more value in terms of health benefits per dollar spent than other measures. Instead of singling out prevention for a requirement that it save money, we need to compare preventive measures with other forms of health care to see which ones provide the most value. And preventive measures seek to reduce the prevelance of chronic diseases that are driving health costs through the roof and that have increased out-of-pocket health expenses by 40 percent over the last decade.

"As for your statement that effective preventive care can increase longevity and improve the quality of life, we plead guilty as charged, and we think that’s a good thing. If living longer costs more, then surgeons and emergency room docs may also want to claim their share of the credit for that. Saving lives is, after all, a big reason for having a health care system, and I think we’d all agree that that premature death as a cost-savings strategy is bad politics, bad policy and bad economics (just ask the folks who lived through the Black Plague). The reasonable alternative is to identify and apply the treatments and preventive measures that provide the most value. Right now, 95 percent of medical spending goes to treatment while less than 5 percent goes to prevention. The results – a high-cost, low-yield health care system compared to other countries - suggest that this is not a proper balance.

"Regarding your concerns about paternalism, our proposals would not tell anyone how to live, but they would help people who want to make healthy choices be able to afford those choices. "