Wednesday, August 12, 2009

Disease Prevention Not Just Screenings

“This weekend, the Congressional Budget Office (CBO) sent a letter to Rep. Nathan Deal and other Congressmen regarding the scoring of prevention, in response to a July 16 question by Deal on the subject. Faithful to CBO’s previous statements, the letter said that investing in prevention won’t yield cost savings to the government, though some forms of prevention can be cost-effective. What CBO says is true, depending on how you define prevention. Prevention is a continuum of care that works in three different ways: averting disease (primary prevention), detecting disease (secondary prevention) and managing disease (tertiary prevention). Much of CBO’s letter is devoted to secondary prevention efforts, i.e., screenings and tests for disease, which they call ‘medical preventive care.’ But if you look at studies on cost savings from prevention, it’s really primary prevention – averting disease in the first place, eating healthy, exercising regularly and avoiding bad habits like smoking — that has shown to yield cost savings. Both the White House and Congress have rallied behind prevention as a cost saving mechanism and a path to health improvement, and I commend them for their efforts on this. However, CBO’s letter underlines a yet-to-overcome hurdle that prevention advocates must surmount if they want prevention included as a sustainable element of health reform, and that’s making sure everyone (CBO, the American public) knows exactly what we mean when we say prevention (and it’s not just disease detection and screenings).”

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