Updated at 5:00 p.m. on Nov. 23 to reflect continuing legislation.
Medical treatment that would prevent a disease or identify it at an early stage.
Modern preventive medicine goes back at least as far as the advent of vaccines in 18th-century England, but as a matter of public policy in America, its potential didn't begin to emerge on a wide scale until late in the 20th century, when tobacco- and obesity-related diseases began to change the public's attitude toward prevention.
Preventive services have come to encompass broader areas such as encouraging tobacco cessation, promoting healthy lifestyles and screening and testing for cancer and other diseases in their earliest stages.
As a result, "prevention has finally moved into the mainstream of medicine," said Dr. Diana Petitti, vice chair of the U.S. Preventive Services Task Force.
Much emphasis has been placed on preventive services as a way to drive down health care costs, especially by Senate Health, Education, Labor and Pensions Committee chairman Tom Harkin, D-Iowa. With better prevention, acute and expensive health procedures can be avoided, thus saving money while improving the population's overall quality of life.
Much emphasis has been placed on preventive services as a way to drive down health care costs. With better prevention, acute and expensive health procedures can be avoided, thus saving money while improving the population's overall quality of life.
But as with extending disease-management services to more people, the vast majority of benefits that preventive services promise will only be realized long after the initial costs are incurred, complicating the balance sheet.
"The time horizon for the payoffs of prevention is long," Petitti said.
Also, blanket statements about the cost-saving capabilities of preventive services can be inaccurate. The New England Journal of Medicine notes "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. Preventive measures that do not save money may or may not represent cost-effective care (i.e., good value for the resources expended)."
The bottom line, Petitti said, is for lawmakers and others to recognize the necessity of using preventive mechanisms to keep people from getting ill, as opposed to treating them later. The challenge lies in finding a way to do so while keeping costs in the black.
The Congressional Budget Office estimates that basing Medicare's coverage of preventive services on evidence of effectiveness would save $360 million by 2014 and $850 million over 10 years. However, CBO Director Douglas Elmendorf noted in his March 10 report to a House subcommittee that "a preventive service could be cost-reducing overall, but if the government began providing that service for free, federal costs would probably increase -- largely because many of the payments would cover costs for care that would have been received anyway."
Works Best When Combined With
As with disease-management services, preventive services of all kinds have become mainstream due in large part to technological breakthroughs. Measuring quality of care also correlates to preventive services through the Deming approach, which advocates a continuous cycle of treatment that aims to detect and treat ailments at an early stage.
Both House and Senate bills address and encourage preventative services. They expand grants for wellness programs, lower co-pays for necessary screenings and have Medicare reimburse for all necessary preventative screenings. In addition, both bills establish councils to explore and encourage community wellness and prevention initiatives.
• 2008 CBO Budget Options for Health Care (requiring evidence of effectiveness is option 110).