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A new Harvard study found that health care spending among people aged 65 and over in Medicare has slowed considerably since 2005, and that half of that reduction can be attributed to reduced spending on health care. cardiovascular illnesses.
Under the direction of David Cutler, professor of applied economics Otto Eckstein, a team of researchers showed that in 2012, these cuts allowed the average person to save nearly $ 3,000 a year. For the entire elderly population, these savings amount to $ 120 billion, of which about half comes from Medicare. The study is described in a February 4 article published in Health Affairs.
"This is the first time, to my knowledge, anyone has shown that some forms of medical care can save money," said Cutler. "You see this claim all the time – but in terms of generalized preventative care that saves money … we have never had this example before."
And while it may seem logical – if you can prevent people from getting sick, they will spend less on health care – the wisdom accepted by economists was exactly the opposite.
"The wisdom received was that prevention does not save money, but only lives," Cutler said. "Of course, it's something we want to do, but the argument was that you should not expect your prevention to save you money."
And part of the reason why, he said, can be reduced to mere numbers.
Prevention programs must include a considerable number of people to be effective, said Cutler, making them expensive, and there is no guarantee that they will actually work. For example, he highlighted smoking cessation.
"If you stop smoking and you do not have a heart attack, you save money that you would spend on heart attack," he said. "But the argument was that because very few people will succeed in quitting, you have to intervene with a lot of people, so the number you have to deal with is high." And the second reason is that maybe you are dying of a heart attack, but you will die of something, and it will always be expensive … so it's largely a wash. "
Cutler's study rejects these arguments, however, showing that even relatively modest investments in preventive care can generate considerable savings.
"When we looked at the per capita spending trend of seniors, it was in 2005 that we started to see the increases slow down," Cutler said. "And a lot of that is due to cardiovascular health, because people with disabilities were primarily heart disease and stroke, and they've gone down a lot … so about half of the decline was related to cardiovascular problems. "
And in 2012, said Cutler, the slowdown in health spending was starting to intensify.
"It was almost $ 2,900 a year per person – it's a lot of money," he said. "Towards the end of Obama's first term, you may remember that there was much talk of debt reduction, but when an agreement was not reached, the One of the reasons is that the costs of Medicare have been slower than we thought … and this study shows a reason why. "
Understanding exactly what caused the slowdown in health care costs was not easy, however.
"There were three main technical challenges in this document," said Cutler. "The most difficult, where we spent the most time, was to try to break down the expenses by disease.This is very difficult, because if someone goes to the doctor for a cardiovascular problem, but he also has a history of mental disorders, how do you separate spending on these items? "
The solution, said Cutler, came when he and his colleagues compared a random sample of billing records of people with similar diagnoses.
"We badyzed everyone who had X, we compared them to people who look like them, but they do not have X," said Cutler. "And then, we can ask how much more people with X have spent?"
The next challenge, Cutler said, was to explain the magnitude of the slowdown in spending due to at least a few cases of cardiovascular disease and the fact that each case cost less, and what the researchers discovered was both There were fewer illnesses and fewer cases where a patient had a problem, such as a heart attack, and then experienced additional problems.
Finally, said Cutler, the team took up the challenge of measuring the impact of drugs on expenses.
To do this, they have created a combined measure of how various medications reduce the risk of cardiovascular disease. When they compared the expected decline of the disease to the actual decline, they found that about half of the decline could be attributed to drugs.
Although the study revealed that improving cardiovascular health resulted in significant cost savings, Mr. Cutler said that there was still room for more. improvement.
"Even now, only half of people with high cholesterol have their cholesterol levels down to indicative levels," he said. "And it's the same for people with high blood pressure, so there is still some way to go."
In the future, Cutler hopes to expand the study to include near-seniors to understand how early intervention can reduce health care costs.
"There is no reason to think that this would be limited to the elderly," he said. "And in fact, forcing 58-year-olds to take medication could save a lot of health insurance because they will be healthier when they enter this population."
In the end, Cutler said, the study provides important evidence that preventative care can not only help people live longer, healthier lives, but can also have a positive impact on their wallet.
"For the first time, we can see savings, which is very rewarding, because very often, when you are thinking about saving money in medical care, you are dealing with unpleasant topics, such as those that should be rationed. by chemotherapy or for which unnecessary services, "he said. "We always knew in principle that if people are healthy, you do not need to spend money on them … but no one has ever had the means to it's what makes me particularly excited about it. "
This research was funded by the National Institute on Aging.
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