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Greater Use of Preventive Services in US Healthcare Could Save Lives at Little or No Cost
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.
... Studies indicate that the dissemination of preventive care services would lead to substantial savings in countries' healthcare expenditures. Hence preventive care offers significant economic benefits and can greatly reduce the individual financial burden associated with emergency healthcare services (Maciosek et al., 2010). Preventive health services are considered a cornerstone of good health and well-being. ...
... Additionally, we explored the influence of various sociodemographic factors on self-rated health status. Age groups were stratified into four distinct categories: emerging adults (aged [18][19][20][21][22][23][24][25][26], young adults (aged 27-45), middle-aged adults (aged 46-64), and elderly individuals (aged 65 and above). The rationale behind this categorization was to account for differences in perceived healthcare needs and subsequent preventive healthcare-seeking behaviours across diverse age groups. ...
... 1. Educate key groups on APMs for SUD prevention An important initial step toward utilizing APMs for SUD prevention is to educate key groups about the potential benefits of this effort, including state-level leaders from Medicaid, insurers, drug and alcohol agencies, community-based organizations, medical associations, and SUD prevention advocacy groups such as prevention coalitions [46]. Conveying to these groups that SUD prevention is a cost-effective means to improve health and save lives, and highlighting its fit with APMs as a financing mechanism, is necessary to gain buy-in for future adoption and implementation of these initiatives [45,47]. ...
Background
Alternative payment models (APMs) are methods through which insurers reimburse health care providers and are widely used to improve the quality and value of health care. While there is a growing movement to utilize APMs for substance use disorder (SUD) treatment services, they have rarely included SUD prevention strategies. Challenges to using APMs for SUD prevention include underdeveloped program outcome measures, inadequate SUD prevention funding, and lack of clarity regarding what prevention strategies might fit within the scope of APMs.
Methods
In November 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA), through a contract with Westat, convened an expert panel to refine a preliminary conceptual framework developed for utilizing APMs for SUD prevention and to identify strategies to encourage their adoption.
Results
The conceptual framework agreed upon by the panel provides expert consensus on how APMs could finance a variety of prevention programs across diverse populations and settings. Additional efforts are needed to accelerate the support for and adoption of APMs for SUD prevention, and the principles of health equity and community engagement should underpin these efforts. Opportunities to increase the use of APMs for SUD prevention include educating key groups, expanding and promoting the SUD prevention workforce, establishing funding for pilot studies, identifying evidence-based core components of SUD prevention, analyzing the cost effectiveness of APMs for SUD prevention, and aligning funding across federal agencies.
Conclusion
Given that the use of APMs for SUD prevention is a new practice, additional research, education, and resources are needed. The conceptual framework and strategies generated by the expert panel offer a path for future research. SUD health care stakeholders should consider ways that SUD prevention can be effectively and equitably implemented within APMs.
... Preventive healthcare services are important not only to avoid certain diseases, but also to identify existing health problems at an early stage, before they cause other issues or become more difficult to treat. This allows for more effective treatment in terms of having a greater impact on the health status of the population, but also in terms of saving total healthcare expenditure [6][7][8]. ...
Background
The European-wide statistics show that the use of flu vaccination remains low and the differences between countries are significant, as are those between different population groups within each country. Considerable research has focused on explaining vaccination uptake in relation to socio-economic and demographic characteristics, health promotion and health behavior factors. Nevertheless, few studies have aimed to analyze between-country differences in the use of flu vaccination for the EU population. To address this gap, this study examines the socio-economic inequalities in the use of influenza vaccination for the population aged 15 years and over in all 27 EU Member States and two other non-EU countries (Iceland and Norway).
Methods
Using data from the third wave of European Health Interview Survey (EHIS) 2019, we employed a multilevel logistic model with a random intercept for country, which allows controlling simultaneously the variations in individuals’ characteristics and macro-contextual factors which could influence the use of flu vaccination. In addition, the analysis considers the population stratified into four age groups, namely adolescents, young adults, adults and elderly, to better capture heterogeneities in flu vaccination uptake.
Results
The main findings confirm the existence of socio-economic inequalities between individuals in different age groups, but also of significant variation between European countries, particularly for older people, in the use of influenza vaccination. In this respect, income and education are strong proxy of socio-economic status associated with flu vaccination uptake. Moreover, these disparities within each population group are also explained by area of residence and occupational status. Particularly for the elderly, the differences between individuals in vaccine utilization are also explained by country-level factors, such as the type of healthcare system adopted in each country, public funding, personal health expenditure burden, or the availability of generalist practitioners.
Conclusions
Overall, our findings reveal that vaccination against seasonal influenza remains a critical public health intervention and bring attention to the relevance of conceiving and implementing context-specific strategies to ensure equitable access to vaccines for all EU citizens.
... These interventions may prevent subsequent comorbidities that then require more intensive management with medication titration, subspecialty referrals, and frequent monitoring. Preventative interventions have been repeatedly demonstrated to reduce patient morbidity, mortality [43], and hospital costs [44], and medical complexity in patient cohorts has been linked to clinician burnout [42]. By preventing medical complexity through guideline-based preventive services, population health management tools may in turn prevent clinician burnout. ...
Background
Technological burden and medical complexity are significant drivers of clinician burnout. Electronic health record(EHR)-based population health management tools can be used to identify high-risk patient populations and implement prophylactic health practices. Their impact on clinician burnout, however, is not well understood. Our objective was to assess the relationship between ratings of EHR-based population health management tools and clinician burnout.
Methods
We conducted cross-sectional analyses of 2018 national Veterans Health Administration(VA) primary care personnel survey, administered as an online survey to all VA primary care personnel (n = 4257, response rate = 17.7%), using bivariate and multivariate logistic regressions. Our analytical sample included providers (medical doctors, nurse practitioners, physicians’ assistants) and nurses (registered nurses, licensed practical nurses). The outcomes included two items measuring high burnout. Primary predictors included importance ratings of 10 population health management tools (eg. VA risk prediction algorithm, recent hospitalizations and emergency department visits, etc.).
Results
High ratings of 9 tools were associated with lower odds of high burnout, independent of covariates including VA tenure, team role, gender, ethnicity, staffing, and training. For example, clinicians who rated the risk prediction algorithm as important were less likely to report high burnout levels than those who did not use or did not know about the tool (OR 0.73; CI 0.61-0.87), and they were less likely to report frequent burnout (once per week or more) (OR 0.71; CI 0.60-0.84).
Conclusions
Burned-out clinicians may not consider the EHR-based tools important and may not be using them to perform care management. Tools that create additional technological burden may need adaptation to become more accessible, more intuitive, and less burdensome to use. Finding ways to improve the use of tools that streamline the work of population health management and/or result in less workload due to patients with poorly managed chronic conditions may alleviate burnout. More research is needed to understand the causal directional of the association between burnout and ratings of population health management tools.
Diabetic screening of Emergency Department (ED)/Urgent Care (UC) patients can proactively improve health outcomes, but it is uneconomic to screen all such patients. Physicians divide patients into three groups: those who should be screened, those who do not require screening, and those who might be screened if resources to do so are available. We present a data-driven analytical approach, using near-time electronic health record data and clinical predictors, that could assist physicians with the yes/no diabetes screening decision. The approach is capable of selecting the most appropriate statistical model as resource availability and the patient’s historical frequency of utilization change over time. Our findings show that when testing resources are more constrained, the approach’s predictive accuracy is greater for frequent ED/UC users and decreases with patient visit frequency. Conversely, when testing resources are more available, the approach’s predictive accuracy decreases as patient visit frequency increases. Overall, the models are much better at identifying patients who do not need screening thus helping to use resources efficiently. For clinical implementation, the proposed data-driven predictive approach would be one component embedded in the ED/UC workflow, capable of personalizing the care path for individuals at-risk for diabetes or who have been diagnosed with diabetes.
The boundaries of psychology are expanding as growing numbers of psychological scientists, educators, and clinicians take a preventive approach to social and mental health challenges. Offering a broad introduction to prevention in psychology, this book provides readers with the tools, resources, and knowledge to develop and implement evidence-based prevention programs. Each chapter features key points, a list of helpful resources for creating successful intervention programs, and culturally informed case examples from across the lifespan, including childhood, school, college, family, adult, and community settings. An important resource for students, researchers, and practitioners in counseling, clinical, health, and educational psychology, social justice and diversity, social work, and public health.
Background
Preventive healthcare is crucial in timely detection of risk factors or symptoms associated with diseases, contributing significantly to reducing treatment expenses in health economics by mitigating potential disease risks at the health level. The aim of this study is to examine the sociodemographic factor and the utilization of preventive healthcare services associated with self-rated health status among adult groups and the elderly in Turkey.
Methods
We conducted statistical difference test analyses to assess the frequency of preventive health service utilization for the perceived health across different age groups. We utilized multilevel ordered probit regression models to scrutinize the self-rated health status, considering factors associated with sociodemographic variables and receipt of preventive healthcare among adult groups and elders by using Turkiye Health Survey (HS) Micro Dataset (2022). Thus, we observed model coefficients and their significances, especially concerning age, within the perceived health levels reflecting individuals' health statuses.
Results
This study highlights a clear and positive association between self-rated health status and preventive health services, particularly in consultations with general practitioners, blood pressure measurements, and blood sugar tests. Notably, regular utilization of these services within past year positively influences health status. This relationship is more pronounced with age, especially among young adults and middle-aged adults. Typically, tobacco and alcohol use have a negative impact on health for each age group, while education level has a positive effect. Additionally, affordability constraints on accessing healthcare services and medication clearly have a negative impact.
Conclusion
Subsidizing primary healthcare, screenings, and expanding healthcare services are essential for effective policy implementation. It is crucial to enhance the accessibility and affordability of preventive healthcare interventions to encourage regular check-ups, particularly among young adults and adults, encompassing gender-based considerations.
Infectious diseases (IDs) know no borders, and Covid-19 tragically and dramatically illustrated that widespread globalization-related trade, travel, migration, and human environmental stressors have worsened the ID threat. The world is battle-weary by the COVID-19 pandemic, yet in many regards less ready for "the next one(s)" from the levels of broader government policy and systemic issues to specific measures that are and will need to be taken to mitigate and effectively respond. Global microbial risks grow steadily in both frequency and salience-exacerbated by budgetary cuts to research, surveillance, and preparedness; the deterioration of both public health and medical infrastructures; the global heating crisis; and anti-science (and anti-government) attitudes damaging institutional credibility. The overall effect is an increase in outbreak frequency, which affects global health, the just in time global supply chain, and economies. Thus, it remains more important than ever for both infectious disease disaster-related stakeholders and students of EM to understand how unique and often highly complex ID disasters can be. This chapter analyzes notable 21 st Century case studies and the international dynamics in response to the outbreaks, which provides foundational discussion for ground level risk management. Importantly, the chapter identifies specific areas for affecting more cohesive collective action in preparing for, responding to, and mitigating future outbreaks within and across borders. Although outbreak risk cannot be eliminated, the cumulative lessons learned across the variety of outbreaks of the 21 st Century holds value for frontline stakeholders, emergency management students, and wider systems stability. 2
Objective
This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease.
Methods
The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes.
Results
The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997–2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017–2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%).
Conclusion
The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies.
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.
Background: 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.Objectives: 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.Methods: 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 14,000/QALY. Only three (6%) of the CUAs met minimum reference case requirements. There was no apparent improvement of methods over time.Conclusions: 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.
We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. “Life-saving interventions” were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs 19,000/life-year; injury reduction 2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.
Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the U.S.
We used person-specific data from a representative sample of the U.S. population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the U.S. today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real U.S. population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible.
Approximately 78% of adults aged 20-80 years alive today in the U.S. are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by approximately 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced approximately 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the U.S. adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the U.S. population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years.
Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the U.S. today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.
We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. "Life-saving interventions" were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs 19,000/life-year; injury reduction 2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.
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 . . .
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 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.
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.
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.
In 2006, U.S. health care spending increased 6.7 percent to 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.