Preventive Care = Lower Cost or Better Value?

Effective Preventive Care Crucial : NPR

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:

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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?

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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?




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  1. Mark Welch says

    Yes, this is very surprising to me, but the credibility of the NEJM is hard to deny. This poses a pretty deep philosphical question: preventive care cost vs. preventive care value, and that's a debate where one can only hope for compromises because the waters get very muddy. Yes, we all want these diagnostic tests, preventive care, etc., but how are we going to pay for it?For me, personally, I'll go with value as more important than cost, because I don't think you can put a dollar value on a person's life. Yes, we may pay a lot more in the long run for many forms of preventive care, but to me, and to those patients whose lives are saved, value trumps cost. The hard thing to determine is, how MUCH more are we willing to pay… No easy answers…

  2. Andy Wagner says

    The analogy is flawed.Screening is not preventative maintenance. It's inspection.Preventative maintenance, like a vaccination, *prevents* the disease before it occurs. Inspection identifies it afterward, which might reduce the cost of treatment for an individual, however there are also risks from *over* treatment of things like cancers that may or may not develop into full blown health risks if allowed to progress. There is a lot of discussion in the medical community about the increased ability of imaging devices to see without a corresponding increase in doctors to know what it is that they are seeing.If we truly want to be preventative, we need to be talking about health measures like countering obesity, quiting smoking, etc..

  3. Andrew Bishop says

    I agree the analogy is flawed as it is drawn: TPM (Total Productive Maintenance) doesn't necessarily call for adding inspections by technicians (doctors), which could be expected to add cost. I do think that we can learn something by looking a little deeper for a TPM analogy in health care. What is the correct analogy? TPM is more than preventive maintenance. It also involves engaging operators in diagnosis and maintenance. What do you, as the operator do each day to take care of the machine? What are you listening for and looking for that will reveal problems or the need for corrective action that a technician or maintenance staff might not notice during periodic checks?That could be the power of "Total Preventve Medicine". Not improved technical intervention (though we need the improvement!) but engagement of the operator (the rest of us) in caring for our health. Duh. Eat right, exercise, quit smoking. Look both ways before you cross the street and wear a helmet when you ride! Learn enough to be an informed patient and to know when seeing a doctor is called for and when it isn't. All of a sudden the cost of health care just went down. I think that's more like TPM than regular check-ups and vaccinations alone!

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