I watch for headlines that promise large health care cost savings – and in general, headlines about public health oriented interventions that are more credible than interventions within the medical care system.
Here’s a headline from UPI this weekend: “Child health interventions save billions. “ You can imagine I found the headline pretty exciting. Frankly, it’s not often that an article from Academic Pediatrics makes national headlines .
This article is a literature review – and it suggests four areas of intervention in childhood that could lower future costs.
(Harvard full text) (NonHarvard PubMed) These areas are
1) Early tobacco exposures
2) Accidental injury
3) Obesity
4) Mental health
Tobacco exposure, injuries, obesity and mental illness take a terrible toll in childhood – and increased costs continue well into adulthood. The authors conclude that there is good evidence that efforts to lower parental smoking and decrease poisonings and accidental injuries work. They admit that the medical literature on effectiveness of interventions for mental health are limited to small clinical studies, and there is less evidence still for medical interventions for obesity.
The calculation of $65-$100 billion in costs is derived thus:
- Assume cost of $50,000 per affected child. Note this “cost” is not limited to cost within the health care sphere – but also includes lost productivity loss and civil justice. I’m not sure how civil justice is valued.
- Assume that 1/3 to ½ of each birth cohort is affected
- Multiply the number of affected children by $50,000.
So – there are probably billions of dollars of excess costs (although the accounting is cloudier than suggested by UPI). Are there billions of savings?
It depends. How much will the intervention cost? How effective will it be? We need a lot more research before we assume that these savings could be realized. These savings certainly can't be counted on to fund increased coverage for the uninsured, or improvements to the educational system.
The authors note that medical care in childhood is 1.6% of GDP, and projected to decline by 14-29% from 2006-2017. There’s some demagoguery in that statistic– since children will represent a smaller portion of the population over the next decade, so we would expect pediatric care to decline as a portion of total medical spending. Even so, most clinicians would agree that a dreadful shortage of child psychiatrists isn’t a good way of saving dollars.
Our commitment to interventions in these areas cannot be judged by how many dollars are spent in pediatric care. Frankly, tobacco cessation and accident prevention efforts come out of public health funds - and they are not likely to be reflected in the percentage of GDP spent on pediatrics. Public health efforts are also cheap compare to initiatives in the medical arena.
