The Economist's Apprentice

In which a little girl confronts the world and battles the anti-humans.

Sunday, August 28, 2005

The Downside of Preventive Care

Conventional wisdom is that preventive care should reduce medical costs, as it will identify problems before they develop into expensive and deadly illnesses. Unfortunately, preventive care also leads to many wasteful medical interventions. Insured patients pay a small part of the cost of care. If preventive care identifies a minor medical problem with a costly solution, an insured patient is likely to undergo treatment, even if the real costs outweigh the benefits. It is likely that the nature of preventive care identifies far more minor problems than potential major problems. Friday's WSJ describes how cancer screening may not be as beneficial as is commonly believed.

...many tumors are so slow to progress - indolent, scientists call them - that they'll hang out in an organ for decades with no ill effects.... can be misled into attributing the decades of life you enjoy after "beating" cancer to early detection and treatment rather than to the properties of the tumor itself.

The article describes how overdiagnosis of cancer is the norm. Many people undergo invasive treatment for a cancer that would have developed so slowly that they would have died of something else first. Some of these patients suffer needlessly from side effects of their treatment. New research will lead to preventive care identifying more patients that can be treated at great expense with little expected benefit.

Researchers in Japan, for instance, find that CT scans detect almost as many lung lesions in nonsmokers as in smokers. But since nonsmokers have a mortality rate from lung cancer less than 10% that of smokers, the vast majority of what CT scans picked up would never have progressed to anything life-threatening. And a Mayo Clinic study found that although X-rays detect lung cancers at earlier stages, and lead to more five-year survivors, early detection does not lower death rates.

While consumers often resist increased cost sharing in their medical plans, financial incentives for patients to reduce wasteful treatment will be increasingly important.


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