April 10, 2008

The Real Cost of Prevention

David Brown, a staff writer with The Washington Post, recently wrote an article defying the common belief that preventing disease is cheaper than dealing with diseases long-term. Part of his thesis:

Preventing those heart attacks is expensive because everyone fitting the risk
profile needs to get the intervention. Why? Because there's no way to know in
advance who the 1-in-4 unlucky men or 1-in-9 unlucky women are.

A worthwhile point, and one not often discussed. The truth is that, if you're playing the numbers, only a fraction of the people being blanket-screened for, say, heart disease (since Mr. Brown uses that as his example) will actually benefit from the screening. That means some amount of dollars will inevitably be spent for nothing.

But the odds are rarely that easy to calculate. The beauty of prevention is that one or two tests can diagnose a myriad of different factors so that the cost of the test is actually spread out over every disease that could possibly be caught with one screening process. The odds, then, are not 1-in-4 or 1-in-9 with heart disease, but those numbers overlapped with the 1-in-4 women with HIV/AIDS, the 1-in-3 suffering from complications of malnutrition, and the many other illnesses and complications that come from living below the poverty line.

The value of an emphasis on prevention is also that, hopefully, the cost of screenings will decrease and more people will pay attention to their health even if they don't change their behaviors (although human nature tells us that once informed at least a sizable minority will change once they know measurable steps). I actually agree with Mr. Brown, to a point, that the argument for prevention is not merely an economic one. But considering that most of these initiatives will be government sponsored, something tells me the economic debate isn't going anywhere.

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