Why prevention can increase health-care spending
ABSTRACT This article examines the impact of disease prevention on health-care spending. The relationship between these two variables is more complex than what, at first glance, appears to be the case. Health-care spending would be reduced if more effective means could be found to prevent health problems that are expensive to treat but are generally not fatal, such as dementia, infectious diseases and accidents. The major focus here is on interventions designed to persuade people to quit smoking. Savings on health-care spending in early years after people stop smoking are counter-balanced (often exceeded) by higher spending at a later time. In addition, when people stop smoking there is a significant negative impact on government finances from the double effect of lost tax revenues combined with increased spending on pension payments. Arguments in favour of policies designed to prevent fatal disease, such as by reducing the prevalence of smoking, should be based on improvements to population health rather than on misleading claims that this will reduce spending on health care.
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ABSTRACT: Some health care institutions, including academic health centers, have adopted policies excluding smokers from employment. Claims advanced on behalf of these policies include financial savings from reduced health costs and absenteeism as well as advantages consonant with their message of healthy living. The authors suggest that the institutional savings from these policies are speculative and unproven. Also, in settings where large medical schools operate, it is likely to be the poor, including members of minority groups, who, under an employee smoker ban, will lose the opportunity to work for an employer that offers health insurance and other benefits. In response to the incentives created by such bans, some will quit smoking, but most will not. Thus, at the community level, employee smoker bans are more likely to be harmful than beneficial.Although private businesses may rightly choose not to hire smokers in the 19 states where such policies are legal, health care institutions, including academic health centers, should consider hiring choices in light of the values they profess. The traditional values of medicine include service to all persons in need, even when illness results from addiction or unsafe behavior. Secular academic communities require a shared dedication to discovery without requiring strict conformity of private behavior or belief. The authors conclude that for health care institutions, policies of hiring smokers and helping them to quit are both prudent and expressive of the norms of medical care, such as inclusion, compassion, and fellowship, that academic health professionals seek to honor.Academic medicine: journal of the Association of American Medical Colleges 06/2014; 89(6):843-7. DOI:10.1097/ACM.0000000000000247 · 3.47 Impact Factor
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ABSTRACT: In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care. To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affected most. Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004-2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse. Mean monthly health care expenditure in married subjects was €502 in the 42 months before the death of the spouse, and expenditure levels rose by €239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (€319; 59%) and the oldest old (€553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together €166). The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.PLoS ONE 12/2014; 9(12):e115478. DOI:10.1371/journal.pone.0115478 · 3.53 Impact Factor