The Models of Prevention and Healthcare Spending
Having established the competing understandings of preventive interventions, this section discusses the opportunities for healthcare savings associated with the different models of prevention. Both the public health and medical models have opportunities for significant contributions to improved health outcomes. The principal issue is that policymakers and administrators make the necessary distinctions between the alternative models of prevention in order to best fit resources and policies to problems.
The Medical Model's Approach to Prevention Most Often Does Not Produce Cost Savings
Cohen et al. warn that, “although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.”25 Russell found that hundreds of cost-effectiveness analysis (CEA) studies have shown that clinical medical preventive services actually add to medical spending, rather than produce cost savings.26 For example, CEA data show how accumulated medical preventive costs for hypertension are higher over time than the cost savings resulting from avoided heart disease and strokes that would have otherwise occurred. This stems from the fact that hypertensive patients require medication for several years. As such the common perception that prevention saves money by avoiding more serious interventions later is simply most often a myth.
Similarly, based on their studies of medical preventive screenings, Cohen et al. point out that “screening costs will exceed the savings from avoided treatment in cases in which only a very small fraction of the population would have become ill in the absence of preventive measures.”27 Russell agrees. Screening for colorectal, cervical, and breast cancer result in higher medical spending compared to savings.28 Even the Congressional Budget Office (CBO) concluded that for most medical preventive services, “expanded use leads to higher, not lower, overall medical spend- ing.”29 In fact, fewer than 20 percent of medical preventive interventions reduce costs.30