Leatherhead Matters

Follow up to my last post….

The Power of Life or Death (revised edition, 1999) by Fabian Tassano clearly recognises the issues around healthcare prevention:

Clients have a right to be warned that they may be denied available life‑saving treatment, and that this may happen for reasons that have nothing even notionally to do with their best interests. A large sign in front of all NHS hospitals, pointing out the serious dangers of relying on state medicine, might do for a start. If people are to be warned incessantly, at the taxpayer’s expense, of the risks of smoking cigarettes, they should certainly be educated about the more invisible risks of relying on a medical system which may choose whether or not to accept any given client.

An ounce of prevention may have been worth a pound of cure in households down through the ages, but in the world of health economics the adage, alas, is not true. This is a seemingly illogical truth. Most of us naturally assume that preventing a disease is cheaper than waiting for the disease to appear and then treating it. That belief is especially dear to politicians, who often view prevention as an underused weapon in the battle against health-care costs.

In 1986, a health economist named Louise B. Russell published “Is Prevention Better Than Cure?,” in which she concluded that prevention activities tend to cost more than they save. Since the book’s appearance, her observation has been borne out by studies of hundreds of interventions — everything from offering mammograms to all women and prescribing drugs to people with high cholesterol to requiring passenger-side air bags in cars and shortening the response time of ambulances.

There are many reasons prevention usually doesn’t save money. Perhaps the most important is that prevention activities target many more people than will ever come down with the disease being prevented. The reason (thankfully) is that people tend to stay healthy for most of their lives, no matter what they do.

Consider a 50-year-old male smoker whose total cholesterol is in the “high” range (over 240); whose HDL, or desirable cholesterol fraction, is “low” (below 40); and who has untreated moderate hypertension. Sounds like a walking time bomb!

It turns out his chance of having a heart attack in the next 10 years is only 1 in 4. For a woman with the same profile, the chance of having a heart attack is 1 in 9. Almost nine out of 10 such people will dodge the bullet by . . . doing nothing.

But who among us would choose 1-in-4 or 1-in-9 odds of having a heart attack if the alternative is to reduce the odds dramatically by taking a pill every day (especially if you don’t have to pay for the pill yourself)?

Extracted from  In the Balance - washingtonpost.com

And there’s the rub. It’s Insurance paid healthcare and nationalised healthcare (NHS) which picks up the cost and is reflected in insurance premiums (rising at 6-8% p.a.) and taxes (under New Labour) rocketing.

So prevention strategies should take economics into account. Unless, of course, the strategy is dreamed up by New Labour where new, NHS screening programmes are announced every month. They then cross their fingers hoping that take-up will be very low or, quietly shelve the programme after a year.

You can read more about the Government’s cynical “NHS health check” programme HERE (but beware if you are of a sensitive nature!)