post by Bill Gardner
Bottom line: prevention can’t play a major role in curbing the rate of growth in health care spending. The rationale for prevention is for health and other economic and social benefits (greater ability to work, enjoy leisure, etc.). [italics added]
The basic idea is that
Spending on Health Care = (Number of Cases) x Spending/Case.
If so, growth in Spending must result from either the increase in Cases, or the increase in Spending/Case. Roehhrig and Rousseau's found that between 1996 and 2006, only about 25% of recent growth in health care costs can be explained by the increased prevalence of diseases. The rest of it resulted from increases in the Spending/Case. Moreover, even if the Number of Cases had stayed constant during this period, the increase in Spending/Case was so aggressive that Spending would nevertheless have grown faster than GDP.
However, I disagree that this shows that "prevention can’t play a major role in curbing the rate of growth in health care spending." I completely agree that our increase in Spending/Case has been the main cause of growth, and I completely agree that we must find more efficient ways to deliver care. But even if increasing Spending/Case is the way Spending grew, it doesn't follow that that reducing it is the only way it could grow or shrink. If we found the means to prevent some of the major chronic illnesses, and thereby reduced the Number of Cases, that would help reduce the growth in Spending.
Roehhrig and Rousseau show that this has happened for a group of diseases for which we have effective prevention strategies:
Our findings do document, however, that changes in clinical prevalence have had an impact on spending growth for certain conditions. One of the greatest public health achievements in the past fifty years is the reduction in cigarette smoking, and this is almost certainly reflected in our finding that spending growth was less than the rate of GDP growth for respiratory conditions, in spite of the rapid growth in treated prevalence and spending for asthma. [italics added]
Spending also fell for cerebrovascular diseases (which include strokes). Again, reduction in smoking contributed to this fall. So the results also suggest that you can reduce health carespending if you can implement effective prevention strategies. Reducing smoking was a home run for prevention; we are behind in the game now, and we need another big hit.