Disease Prevention as Cost Avoidance

Steven Woolf, in a Commentary in JAMA (February 4, 2009) looks at the potential for cost avoidance with prevention and screening and makes the valid point that "it makes sense to invest in a well-defined package of preventive services". President Obama recently made the point, while speaking about the recovery bill that preventive services can save money for the nation in the long run. While this focus on health and prevention is laudatory, I worry about this becoming an excuse to blame patients who are unsuccessful in trying to modify their lifestyles.

Most successful prevention starts with making very difficult lifestyle changes. Exercising, eating right and stopping smoking have major effects on health and health care costs but are often unsuccessful. Only 5 - 10% of those who try to stop smoking on their own succeed. Only 5% of those who try to lose weight actually lose weight and keep the weight off. With 90 - 95% failure rates for these lifestyle changes, the danger to avoid is punishing people for those failures and blaming them for the nation's high health care costs.

People can do everything right and still get sick. The question "what did you do to yourself?" is often asked when someone is ill even thought the implication is of guilt on the part of the patient.

The focus on prevention is good but has to be combined with support of those people who get sick despite their best attempts. Illness is not optional and even those who try and lose weight and exercise can get sick and need care.