Preventive Care = Lower Cost or Better Value?
Lean thinkers, especially in manufacturing, know about TPM, aka Total Productive Maintenance. It becomes intuitive to a lean thinker that taking care of machines and equipment saves money in the long run. TPM leads to higher uptime and lower costs. Think of your car… if you take care of it properly, it should cost less to maintain in the long term (unless there's data that suggests otherwise…)
We often take that intuition and carry it across to our own bodies — that better “preventative maintenance” of our bodies leads to lower healthcare costs… except it doesn't.
I don't have the article handy anymore, but I remember seeing an overly simplistic analysis in Men's Health magazine a few months back. It laid out the “savings” by comparing the cost of a test (let's say $100) with the cost of treating the disease if it wasn't caught as early ($200,000). They forgot to take into account that each test doesn't prevent a disease (yes, they really laid it out in such a ridiculously simple way). You have to figure in the percentage of the time a test leads to catching something – comparing the “expected values” not just the simple costs.
From a commentary on NPR:
DOUGLAS KAMEROW: Not only do many politicians believe that prevention reduces health care costs, but so do most Americans. In a recent survey, 77 percent of Americans agreed that prevention will save us money. It's only logical – find a disease early in its course, treat it and you not only prevent illness and suffering, but you also save the money you would've spent treating it later.
Except that usually it's not literally true. Here's the dirty little secret: most prevention doesn't save money any more than treatment saves money. The question to ask is not whether it saves money, but whether your money is buying good value in health.
As a source, here's some research from the New England Journal of Medicine. Here's an ABC News summary of the Congressional Budget Office's assessment that preventive medicine costs more. Even if more preventive care doesn't lower overall healthcare costs, isn't it better to have better value (better health) for that same amount of spending?
Now, it turns out that some preventive medicine does actually save money. For example, the cost of vaccinating an entire population against some diseases is actually less than it would've cost to treat those diseases if they developed in some of the people.
But most types of prevention don't literally save money. The reason for this is that you have to screen a lot of women with mammography, for example, in order to find one breast cancer. So, if it doesn't save money, how do we decide what prevention is worth doing? That's where value comes in.
Surprising to the Lean thinkers who are reading?