An article in the February 14, 2008 New England Journal of Medicine presented the most recent and largest compilation of evidence. Based on 599 studies published between 2000 and 2005, the authors reported that spending more on prevention increased medical spending over 80 percent of the time. The situation hasn’t changed since I concluded in my 1986 Brookings Institution book, Is Prevention Better than Cure?, that prevention usually added to medical spending.
Prevention comes in many forms: vaccines; treatment of risk factors for disease, such as elevated blood pressure or cholesterol; screening to catch disease early, when it may be more treatable; programs and advice to help people alter habits like smoking or overeating, which put them at higher risk of disease.
While a few of these approaches can save more than they cost (such as flu vaccines for the elderly, when the cost per dose of vaccine is low enough), most add to medical spending. The additional spending can be modest. Smoking cessation programs cost just a few thousand dollars for each year of life they save. But in other cases the additional spending is substantial.
LOUISE B. RUSSELL
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