Reducing Cardiovascular Disease
Opportunities and consequences
- Peter J. Neumann, SCD and
- Joshua T. Cohen, PHD
- From the Tufts Medical Center, Center for the Evaluation of Value and Risk in Health, Boston, Massachusetts
- Corresponding author: Peter J. Neumann, pneumann{at}tuftsmedicalcenter.org
One of the enduring myths in health care is that prevention saves money. The intuition behind the idea appears unassailable: if we spend a little money on preventive measures, we can avoid the expensive complications of disease. The maxim “an ounce of prevention is worth a pound of cure,” coined by Benjamin Franklin and listed in the Dictionary of Cultural Literacy (1), seems self-evident such that it does not warrant serious challenge. The “prevention saves money” argument is popular with many politicians and health policy makers. For example, the recent Presidential primary season witnessed pledges from many candidates not only to improve health care but also to save money by spending more on prevention (2).
Careful analysis has shown that while preventive care sometimes saves the health system money, usually it does not (3). Economic evaluations tend to conclude that although preventing the need for treatment can offset some costs from avoidable illness, the overall costs can be substantial because of the number of people who must undergo preventive measures (2). Moreover, prevention does not avert death; it only postpones it. As people age, their health costs increase. Therefore, activities and programs that achieve savings by preventing a fatal disease can lead to downstream health care costs as the people who would otherwise die grow older.
Of course, this result does not mean that as a society we should not invest in prevention …
