Preventative Medicine Does Not Save Money

Here's a new study out of the Netherlands (and a Washington Post article about it) that concludes that preventing obesity and smoking may not save money, and may in fact cost more. Although the health care costs for a given time period (say 10 years) was higher for obese patients and smokers compared to healthy non-smokers in the study, the authors state that the total lifetime health care costs were actually higher for normal weight non-smokers because of their longer life spans (obese people and smokers die younger - 5 and 7 years sooner, respectively).

A friend of mine in medical school and I used to question the economic argument in support preventive medicine, that is, it saves money in the long run to prevent diseases than to treat them. Preventative medicine, however, usually does not prevent disease so much as delay it. Although we may live longer (and healthier) with preventative medicine, we will still ultimately succumb to an illness in our old age - in spite of preventative medicine to prevent it. The fact that I die of a heart attack at the age of 85 instead of 75 may be great for me and my grandkids, but that means 10 more years of health care costs incurred by society, and at an age when I am no longer productive and entirely siphoning off resources from the system.

To complicate this, consider that health care costs per patient generally grow exponentially as we age, so that my medical needs in my 80s will be considerable more than in my 60s. Also, the epidemiology of disease changes as we get older. People in this country die from cancer and heart disease a lot more than people in Africa because the risk of cancer and heart attacks increases considerably as you age (Africans, sadly, tend to die before this point). Cancer, compared to tuberculosis or malaria, is also a phenomenally expensive disease to treat.

The most widely recognized benefit of preventative medicine is an increase in quality of life years, not economic savings. And this is far more important than dollars and cents anyway. Nevertheless it is important to acknowledge that preventative medicine will likely cost us more not less as we continue the lively public discourse on health care reform.

Does Preventive Care Save Money? Health Economics and the Presidential Candidates
NEJM