Much has been said about the merits of preventive medicine. It’s been a major talking point for politicians on both sides of the aisle throughout the health care reform debate. Whatever reform measures end up being enacted, there is likely to be an enhanced focus on screening tests. We frequently hear from clients who are looking for a health insurance policy with more preventive care – and people will sometimes pay quite a bit more for a policy because it has some extra preventive benefits worked into the coverage. Here in Colorado, the Anthem Blue Cross Blue Shield Lumenos HSA qualified plan is particularly popular, in part because of the extensive coverage provided for screening tests and preventive care.
But does preventive medicine really help? It definitely gives people peace of mind and is a feel-good benefit on health insurance policies. And anything that enhances peace of mind is providing some degree of benefit. But what about long term outcomes and effective use of health care dollars? Stacey Butterfield, at ACP Internist has written an article addressing this question, and it’s well worth a read. She focuses on a study that indicates that pap smears might be overused in younger women, and that the rush to colposcopies following an abnormal pap might be unwarranted.
I believe preventive health care is important, but I think that we might be coming at it from the wrong angle. Legislation dealing with preventive care tends to focus on increased access to screening tests. We like to believe that if we all get poked and prodded on a regular basis, with numerical values assigned to everything from our bone density to our blood glucose levels, that we can ward off illness. Of course all of those tests are expensive, regardless of whether they’re paid for by the government or by private health insurance companies. And containing health care costs is supposedly one of the main priorities of health care reform.
Remember when Obama said that we should all be more diligent about keeping our tires properly inflated? People laughed, because as a society, we tend to want solutions that are complex and technical. We want big and grandiose, when small and simple might actually do the trick. Preventive medicine in the form of screening tests isn’t actually preventive if you think about it. Catching an illness in an early stage isn’t really the same thing as preventing the illness in the first place. Yes, early detection is preferable to not seeking care until one has stage IV cancer, but wouldn’t it make more sense to actively promote real prevention? What if we encouraged (ie, paid) doctors to do more active prevention with their patients? Yearly consultations about lifestyle issues like diet, exercise, alcohol and tobacco use, junk food consumption, seat belt use, safe sex, etc. could go a long way towards real prevention. Some doctors are already working on this, but much more could be done. And if the government really wanted to focus on preventive medicine, this might be a more effective way to go about it than costly screening that may or may not actually improve patient outcomes.
I found Stacy’s article in Grand Rounds, hosted this week by Dr. Rich at the Covert Rationing Blog.