Tuesday, October 16, 2007

Preventive Health Care

  • An annual report on cancer rates in the U.S. released yesterday "shows cancer death rates decreased on average 2.1 percent per year from 2002 through 2004, nearly twice the annual decrease of 1.1 percent per year from 1993 through 2002." According to HealthDay, Dr. David Espey, a cancer epidemiologist
    from the U.S. Centers for Disease Control and Prevention in Atlanta,

    "We have a lot of work [to do] in colorectal cancer. We've been making progress in lung cancer, but that's a perennial battle to try to control tobacco use initiation and tobacco cessation."

    The "low-hanging fruit" in terms of cancer prevention and early detection right now is colorectal cancer, Espey continued. Less progress has been made here than in breast and cervical cancer, he said.

    FEHB plans cover routine tests for colorectal cancers, such as periodic colonoscopies upon reaching age 50. Covering the cost is only half the battle when it comes to uncomfortable tests like these, but it's hard to read stories like this without realizing extending your life is worth the discomfort.

  • The Milken Institute has a created an interesting web site based on its study "An Unhealthy America: The Economic Burden of Chronic Disease." Utah is the state with the lowest incidence rate for seven common chronic diseases and West Virginia has the highest incidence rate. The study makes two recommendations:
    The incentives in the health-care system should promote prevention and early intervention. Employers, insurers, governments, and communities need to work together to develop strong incentives for patients and health-care providers to prevent and treat chronic disease effectively. In many respects, we’ve received what we paid for: a tiny fraction of health-care spending is devoted to the promotion of healthier behavior, despite the fact that preventable chronic diseases are linked to smoking, obesity, lack of exercise, and drug and alcohol use.
    As a nation, we need to renew our commitment to achieving a “healthy body weight.” Increasing obesity rates threaten to send treatment costs for diabetes and related conditions, such as heart disease and stroke, soaring over the next twenty years. There needs to be a strong, long-term national commitment to promote health, wellness, and healthy body weight.
  • Finally, the National Coalition on Health Care issued a report on the cost effectiveness of preventive health care services. According to the author, Louise B. Russell
    [I]t is impossible to generalize about preventive interventions as though they were all alike. In particular, the evidence does not support the commonly accepted idea that prevention always, or even usually, reduces medical costs – although it sometimes does. Most preventive interventions add more to medical costs than they save, at the same time that they improve

    But even that statement needs to be made more specific. Preventive interventions need to be evaluated individually. Some, like smoking cessation programs, may be good investments almost regardless of how they are applied – they bring additional good health at a very reasonable cost. Other interventions are good investments when used selectively – targeted at those people who benefit most from them – bu not such good investments when used for more broadly defined groups of people.
    At the end of the report the author has included a table that evaluate the cost effectiveness of various preventive treatments.

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