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Report: Prevention Should Play Critical Role in Overhauling Health Care

By Meghan McCarthy, CQ Staff

October 21, 2008 -- Trust for America's Health (TFAH), a nonprofit and nonpartisan health advocacy group, issued a new report Tuesday stating that prevention should play a significant role in any major effort to overhaul health care in America.

Preventative measures will reduce the cost of health care, according to report, which is meant as a guide to the new administration and Congress.

"Disease prevention needs to be a cornerstone. We will never contain costs without a commitment to health prevention, because we won't be able to even afford health reform," said Jeffrey Levi, author of the report and the executive director for TFAH.

Based on analysis conducted in conjunction with the New York Academy of Medicine, researchers found a shortfall of $20 billion per year in spending on public health, which TFAH says encompasses emergency preparedness efforts and preventative care measures, such as education on healthy diet and exercise. Researchers said a review of Organization for Economic Cooperation and Development (OECD) countries' spending on public health found that the United States spends $24 billion less than the average percentage expenditure of other OECD countries.

"In almost all OECD countries there is a larger investment in prevention . . . we also see the cost of health care is lower there. Is it the only the reason? I would say 'no', but is it a contributing factor? I would say 'yes,' " Levi said.

He also emphasized the report's findings of significant returns on the investment of health care dollars in preventative care. For every $10 per person invested in a "proven" community prevention program, over $6 would be returned for every dollar invested in ten to twenty years, according to the report.

Both presidential campaigns are on record supporting some form of preventative health care. In an issue of the New England Journal of Medicine, Republican nominee John McCain of Arizona called for the creation of a "next generation of efforts to prevent chronic disease," and Democratic candidate Barack Obama of Illinois committed to new funding for "community-based programs aimed at priority public health problems such as smoking and obesity."

In a September briefing on Capitol Hill, Richard Hamburg, director of government relations for TFAH, urged the Congressional Budget Office (CBO) to give a greater value to prevention efforts in its analysis of the cost of health care legislation.

But at a news conference on Sept. 9, 2008, CBO Director Peter Orszag was hesitant to commit to using prevention in scoring when asked about it.

"We do take those [prevention programs] into account when there is evidence of their efficacy," Orszag said. "But it is unfortunately the case in a lot of examples where people think there's sort of good evidence, but when you scrub the evidence a little bit, it turns out not to be so great."

Researchers also said that focus groups believed the government has an important role in helping Americans access preventative care measures.

"We asked people about prevention, and they see three entities responsible: the individual is most responsible, businesses are seen as somewhat responsible, but the government also has a role. It's not telling people what to do, but helping people make healthy choices, and making options available to people who would not have them, particularly children," said Alan Quinlan, president of Greenberg Quinlan Rosner Research, which conducted portions of the study.

The report was signed by over 140 organizations, including AARP, the American Federation of State, County and Municipal Employees, the American Heart Association, and the American Lung Association.

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