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Preventive care comes with a cost
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![Michael D. DePaolis, OD, FAAO [photo]](images/commonart/depaolis.jpg)
“An ounce of prevention is worth a pound of cure.” This is undoubtedly a phrase familiar to all of us and one that has become a lexicon in many industries, health care included. In fact, it’s the premise on which preventive medicine – and the HMO model – has been built. It’s an appealing concept in that it’s simply stated, easily understood and resonates well with the public (our patients). After all, who isn’t in favor of a proactive health care system that reduces catastrophic illness and improves quality of life?
While preventive medicine has largely been successful, it hasn’t been without cost. Literally. Even though HMOs dominate our delivery system, health care costs – and attending subscriber premiums – continue to outpace inflation. It’s simply the price society pays for improved quality and quantity of life. Consider the following scenario.
The cost of prevention
A 45-year-old male undergoes a comprehensive physical examination and, while he is asymptomatic, blood work reveals an elevated cholesterol profile. His physician appropriately counsels him on the repercussions of doing nothing (increased risk of cardiovascular event) and the importance of diet and exercise in lowering cholesterol.
Even though the patient complies, a repeat blood test reveals very little change in cholesterol levels. He is subsequently prescribed a statin medication daily, scheduled for subsequent blood work (watch those lipid enzymes) and monitored periodically. While this story has a happy ending – the likelihood of a longer, catastrophic-free life – it isn’t without cost. The additional physician visits, medications and lab studies are, again, the price society pays.
The good news is that preventive medicine is not always associated with significant cost. Early modification of diet and lifestyle can have a profound impact on long-term outcomes, and without significant cost.
Prevention makes sense
Consider age-related macular disease. While the pre-eminent risk factor for AMD is age, contemporary literature suggests that smoking, poor diet, collateral systemic disease and, perhaps, even short wavelength blue light exposure play a role. While we probably won’t have definitive answers regarding AMD risk factors for some, certain professional recommendations make sense. Indeed, with rare exception, suggesting that patients not smoke, exercise regularly, consume fruits and vegetables daily (remember those carotenoids) and wear sunglasses is prudent advice – advice that makes sense to patients as well.
At a time when health care is being constantly criticized for escalating costs, it’s more important than ever that patients understand one fundamental tenet: increased quality of life and longevity does come with a price. Only when society adheres to sound dietary and lifestyle principles will the burden ultimately lessen. Simply put, while it’s true that “an ounce of prevention is worth a pound of cure,” it’s equally true that there is “no such thing as a free lunch.”