The Truth About Prevention

In this weekend's Wall Street Journal, Abraham Verghese's lead article "The Myth of Prevention" provides a doctor's take on preventive care. Its tongue-in-cheek subhead (shown here) emphasizes that when medicine is a business, wellness doesn't pay.

Several conclusions offered by Dr. Verghese hit home.

Medicare is a system that pays well when something is done to a patient, but pays poorly when something is done for a patient. It pays for diagnostics, procedures and drugs, and providers earn more when they deliver them efficiency. It does not reward time spent on getting to know patients to help understand their problems and following up to ensure a proper recovery and good health.

Based on Medicare incentives, most prevention strategies are medical, not personal. We engage in expensive screenings to look for early signs of conditions throughout the population so we can intervene or conduct further tests. We're less likely to take on lifestyle modification.

Dr. Verghese cites an axiom of medical economics that appeared spent in the Annals of Internal Medicine: "A dollar spent on medical care is a dollar of income for someone." He sees doctors, hospitals, pharmacists, drug companies, nurses, home health agencies and health insurers all feeding at the same $2.1 trillion trough and fighting for their share.

Unfortunately, medicine must be run as a business. Organizations and individuals involved in the practice of medicine (or health care in general) are trapped between fulfilling their missions and meeting their margins.

Dr. Verghese believes that a medical approach to preventive care can drive up costs, instead of saving them—such as prescribing statins that end up costing $150,000 for every year of life they save in men (and even more in women).

The truth about prevention is that as long as our healthcare system rewards what we do to patients and not for them, our approach to prevention will remain medical.

What we need—and really want as individuals—is a personal approach that helps us preserve good health and allows us interact freely with doctors and other medical professionals when we're sick, so they can take time to understand us and practice the fine art of healing.

—Tom DeSanto
Image: Wall Street Journal