A View from the UK: Is Preventive Care "Worth It?"

I'm enjoying a weekend with London-based friends who travel the world and know what's what. Today, we spent hours relishing (literally) the Borough Market in Southwark, located south of the Thames. This is London's oldest food market, established when the Romans built the first London Bridge. The Market in its current state has been around for a quarter of a millenium.

The Market boasts and hosts a glorious array of green grocers, bread bakers, Spanish food purveyors, brownie makers, organic tofu purveyors, and parmigiano reggiano vendors in one spot I've seen, perhaps ever. It is foodie heaven and a haven for artisanal, slow food aficionados. Lunch at Roast, the restaurant overlooking the market, capped off this lovely foodie jaunt.

Over lunch, where I savored an unhealthy but incredibly comforting and savory dish of calves liver, bacon and onions (I AM in England, after all), my friend and I talked about...health care. She told me of a friend she has, educated and savvy herself, and a Brit, who recently went for her first mammogram. The woman is around 50 years of age and had never, ever been for a mammography exam. A week or so after the mammogram was taken, the woman was called by her doctor -- there was a scare -- so naturally, she freaked out which is what we tend to do with a call about a mammogram follow-up.

We talked about the fact that the National Health Service (NHS) neither mandates nor covers mammograms for women in the UK until they are 50 years of age. In fact, my friend told me, there is very little preventive care stressed by the NHS. It is a system that is geared toward caring for you when you are sick; thus, some refer to it a "National Sickness Service," not a national "health" service.

I told my friend that we in the US are more geared toward prevention, but even so, there is much work to be done in the area of smoking cessation, weight control and physical fitness. Still, the fact that since mammograms and bone density exams are urged and covered for women at a younger age, and prostate exams for men, too, one would think that Americans would demonstrate a healthier profile overall vs. Britons.

This is not the case, I explained. Americans have poorer health outcomes than Britons. The data proving this appeared in the Journal of the American Medical Association in 2006. The population that stereotypically feasts on fry-up breakfasts and pub crawling demonstrates a higher level of health than the US which obsesses over fat-free this and 100-calorie snack packs conveniently packaged for a people on-the-go. This is even true for Americans of higher socioeconomic status.

In this week's New England Journal of Medicine, go read the article, "Does Preventive Care Save Money? Health Economics and the Presidential Candidates." It's an eye-opener. The authors, a crackerjack team of clinicians and a health policy analyst from Tufts and Harvard point out that every preventive effort isn't necessarily cost-saving; in fact, many increase costs without providing much benefit whatsoever. The chart on the right demonstrates that not every preventive measure is cost-effective as measured in QALYs.

Health Populi's Hot Points: The issue of preventive care is a top talking point for Presidential candidates this year. In a time when Americans are transfixed on health reform, whether we lean right or left, let's all make sure we know what works in terms of preventive care, and what doesn't. That's sound policy for health reform and fiscal wisdom. For my part, I promise to strategically ration my liver-and-bacon intake henceforth.