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Greater Use of Preventive Services in US Healthcare Could Save Lives at Little or No Cost

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Abstract

There is broad debate over whether preventive health services save money or represent a good investment. This paper analyzes the estimated cost of adopting a package of twenty proven preventive services--including tobacco cessation screening, alcohol abuse screening, and daily aspirin use--against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million life-years annually. What's more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending. These findings suggest that policy makers should pursue options that move the nation toward greater use of proven preventive services.
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... [10][11][12][13] However, there is uncertainty among the public as well as the health-care professionals regarding the effectiveness and the feasibility of utilizing these services in a beneficial, judicious, and cost-effective manner. [14,15] This concern has been countered by other researchers who reported higher mortality rates in the absence of regular PHC and increased survival in cases of routine PHC. [16,17] They also assert that preventive health services reduce eventual demand for medical care, thus, enhancing the economic efficiency. ...
... [16][17][18] Despite this, they are under-utilized due to the speculation regarding their efficacy and efficiency. [14,15] Hence, this study was conducted to evaluate the sociopsychological and biochemical determinants of health and disease in executive health check-up, as well as to employ them for encouraging people to utilize preventive health services the observation made in the present research are in concordance with Velupillai et al., who also determined that health is influenced by psychological, social, and biological determinants (P < 0.05). [23] They found that socio-economic gradients in health were influenced by environmental conditions, personal and professional relationships, knowledge, lifestyle choices and altered mental functions, that predisposed the participants toward the practice of health-promoting or health damaging behaviors. ...
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... Some suggest that alternative payment approaches are likely to support SBI provision given their population health focus [26,28]. Shared savings approaches, where the provider benefits from any cost savings they demonstrate for their patient populationd which are generally related to provision of preventive services such as SBIdmay strengthen provider willingness to consistently implement SBI [83]. This might be most likely in Accountable Care Organizations or similar mechanisms related to major payers such as Medicaid where savings across sectors can be measured [84]. ...
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To examine services delivered during preventive care visits among reproductive‐age women with and without chronic conditions by physician specialty. National Ambulatory Medical Care Surveys (2011‐2018). We examined provision of specific services during preventive care visits by physician specialty among reproductive‐age female patients, overall and among women with five common chronic conditions (diabetes, hypertension, depression, hyperlipidemia, and asthma). The sample included preventive visits to OB/GYNs or generalist physicians where the patient was female, age 18‐44, and not pregnant. In OB/GYN preventive visits, reproductive health services were more likely to be provided, while non‐reproductive health services were less likely to be provided, both among reproductive‐age female patients overall and among those with chronic conditions. For example, pap tests were provided in 44.5% of OB/GYN preventive visits (95% CI: 40.6‐48.4) and in 21.4% of generalist preventive visits (95% CI: 17.2‐26.6). Lipid testing was provided in 2.8% of OB/GYN preventive visits (95% CI: 1.7‐3.9) and in 30.3% of generalist preventive visits (95% CI: 26.1‐34.6). Understanding the full range of care received in preventive visits across settings could guide recommendations to optimize where reproductive‐age women with chronic conditions seek care.
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A popular component of the candidates' plans for controlling spiraling health care costs involves greater promotion of preventive health measures. Joshua Cohen, Peter Neumann, and Milton Weinstein write that sweeping statements about the cost-saving potential of prevention, however, are overreaching.
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In this issue of the Journal, Fries et al.1 offer an attractive alternative to health care cost-control proposals such as managed competition, global budgets, rationing, and the like. On behalf of the Health Project Consortium, they propose that wider use of preventive care, broadly defined, would control growth in medical expenditures and make Americans healthier at the same time. Fries et al. are not the first to suggest that prevention saves money -- the idea has enduring appeal. Cost-effectiveness studies, however, provide little evidence of savings. At the same time, the expectation that preventive care will save money may hold . . .
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Cost-effectiveness analyses of clinical preventive services are a potential means to aid public health resource allocation. Cost-utility analysis (CUA) is a specific form of cost-effectiveness analysis where results are expressed in terms of cost per quality-adjusted life year (QALY) gained. To increase the transparency and comparability of CUAs, standardization of methods has been recommended. The purposes of this study were as follows: (1) identify published articles with original CUAs of primary and secondary clinical preventive services, (2) summarize the ratios found in these analyses, (3) identify articles employing comparable methods, and (4) explore analytic methods employed over time. As part of a larger study we conducted a comprehensive search of published CUAs in the area of clinical preventive services and systematically collected data on the results of the analyses and analytic methods employed. Cost-effectiveness ratios were standardized and organized into a table.Results: We found 50 CUAs pertaining to clinical preventive services (primary, n=22, 44%; and secondary, n=28, 56%) and 174 cost-effectiveness ratios. These ratios ranged from cost-savings up to $27,000,000/QALY, with a median of $14,000/QALY. Only three (6%) of the CUAs met minimum reference case requirements. There was no apparent improvement of methods over time. Immunizations and chemoprophylaxis have the most favorable cost-effectiveness ratios, and preventive services are more cost-effective when targeted at high-risk populations. However, there is wide variation in the methods used in these analyses. This study allows us to define where improvements in methodologic rigor need to occur, provides a base-line for future audits, and highlights disease areas in clinical preventive services that have been omitted or underevaluated.
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Decision makers want to know which healthcare services matter the most, but there are no well-established, practical methods for providing evidence-based answers to such questions. Led by the National Commission on Prevention Priorities, the authors update the methods for determining the relative health impact and economic value of clinical preventive services. Using new studies, new preventive service recommendations, and improved methods, the authors present a new ranking of clinical preventive services in the companion article. The original ranking and methods were published in this journal in 2001. The current methods report focuses on evidence collection for a priority setting exercise, guidance for which is effectively lacking in the literature. The authors describe their own standards for searching, tracking, and abstracting literature for priority setting. The authors also summarize their methods for making valid comparisons across different services. This report should be useful to those who want to understand additional detail about how the ranking was developed or who want to adapt the methods for their own purposes.
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Decision makers at multiple levels need information about which clinical preventive services matter the most so that they can prioritize their actions. This study was designed to produce comparable estimates of relative health impact and cost effectiveness for services considered effective by the U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices. The National Commission on Prevention Priorities (NCPP) guided this update to a 2001 ranking of clinical preventive services. The NCPP used new preventive service recommendations up to December 2004, improved methods, and more complete and recent data and evidence. Each service received 1 to 5 points on each of two measures--clinically preventable burden and cost effectiveness--for a total score ranging from 2 to 10. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. The three highest-ranking services each with a total score of 10 are discussing aspirin use with high-risk adults, immunizing children, and tobacco-use screening and brief intervention. High-ranking services (scores of 6 and above) with data indicating low current utilization rates (around 50% or lower) include: tobacco-use screening and brief intervention, screening adults aged 50 and older for colorectal cancer, immunizing adults aged 65 and older against pneumococcal disease, and screening young women for Chlamydia. This study identifies the most valuable clinical preventive services that can be offered in medical practice and should help decision-makers select which services to emphasize.
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In 2006, U.S. health care spending increased 6.7 percent to $2.1 trillion, or $7,026 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than in 2005. Prescription drug spending growth accelerated in 2006 to 8.5 percent, partly as a result of Medicare Part D's impact. Most of the other major health care services and public payers experienced slower growth in 2006 than in prior years. The implementation of Medicare Part D caused a major shift in the distribution of payers for prescription drugs, as Medicare played a larger role in drug purchases than it had before.