Prevention and the cost of health care

Globally costs of health care are rising fast. In the period 2000-2009 in the OESO costs for health care rose a 4,7% on average. The biggest spender as percentage of GDP is the U.S. (17,6% in 2010), followed by the Netherlands (12,0%).  Only about a quarter of the growth in health care is related to demographics, like ageing and prevalence of welfare illnesses (COPD, diabetes, heart failure, obesitas).  About another quarter is related to new treatment possibilities, and the rest is sheer growth.

Healthcare is pushing away other public spending, especially in a time of zero economic growth, and governments feel the urge to limit the growth of public health care spending. One apparently obvious solution would be to invest in prevention of illnesses. In table 1 the costs of behavior-related illnesses are presented for residents in the Netherlands.  You can see that for example 86% of lung cancers are attributable to smoking. This means that prevention of smoking could decrease health care costs with possibly 280 million euro.

Table 1: Contribution of unhealthy behavior to the cost of health care of causally related illnesses for residents in the Netherlands, aged 20 or older in 2010.
		Attributable to (in percentages)
	Costs in million euro	smoking	obesity	inactivity	alcohol
Diabetes	1.137	7	51	10	0
Lungcancer	326	86	0	0	0
Cancer_others	1.618	12	8	5	8
Acute_myocard_infarct	706	40	15	16	-16
Chronic_heartfailure	545	15	12	0	0
Stroke	1.918	22	6	24	-26
COPD	880	79	0	0	0
Arthrose_hip	150	0	14	0	0
Arthrose_knee	146	0	29	0	0
Low_backpain	1.116	0	7	0	0
Total	8.543	24	13	9	-6

Table 1 also provides us with a rationale for doing what we students do best: drinking! The next beercantus could prevent your next coronary infarct, and save society 500 million in costs for strokes. Cheers!

So does this table provide us with a cheap solution to the rising health costs, the famous easy pickings? Obviously not. With an incidence of 100% the greatest cause of death is birth. People die, be it not from COPD then some other (more expensive) illness will do the trick. If prevention measures save a person from lung cancer, that same person might get dementia, Parkinson’s, and fracture a couple of hips on the way to the hospital. And then I didn’t mention the costs of residence or retirement benefits!

Actually most health care costs are made in the last life year, regardless of age. So from a sustainable health care point of view prevention will not do any good. The personal benefits are large though, in the form of increased quality of life. The costs to society are almost as large, in the form of increased social services. I see some freerider options here, but in my role as public servant I would recommend to you smokers: keep on steaming, you’ll reach the harbor faster!