Will preventive services lower health care costs?

One of the buzz words during the health care reform debate was prevention. The idea is to prevent people from getting sick, or diagnose and treat their problems early, before they turn into full-blown catastrophes.

As a result, the health care law will require new insurance policies in starting September.

Medicare will also make changes in January, to cover many preventive services at 100 percent. But it's not clear that more preventive services will lower the cost of health care.

At a downtown Minneapolis health clinic, internist and pediatrician Dr. Janine Pingel said she's always thinking about how to prevent patients from getting sick.

That can range from making sure children like 8-year-old Zoe are growing at the proper rate, to ensuring toddlers are getting their immunizations to ordering a colonoscopy for a man in his 60s. Pingel said eliminating the co-pay will mean more people will have access to these kinds of services.

"With the economy in the last few years it is not unusual for a patient to come to clinic and say to me, 'Do I really need this test? How much does that test cost? Which test should I do first if I have to do them?'" Pingel said. "And that's a very uncomfortable position for a physician to be in."

Just what procedures will be covered isn't completely clear, since the Department of Health and Human Services hasn't detailed its regulations yet. HHS is expected to follow recommendations from the U.S. Preventive Services Task Force, the same group that encountered pushback last year when its recommendations for breast cancer screening drew fire.

Blue Cross Blue Shield of Minnesota Vice President Kathy Dunmire said most of her company's policies already cover preventive services.

"We do have a couple of policies today that are more catastrophic in nature, they're designed to be very low premium plans that give people coverage in case of a catastrophic event. those will have to change," Dunmire said. "But other than that, for our plans that currently offer first-dollar coverage for preventive care, very minor changes."

Some people who work for big companies that pay for their own insurance could see some changes. Dunmire says that's because now those companies design their own benefits.

The National Business Group on Health, represents large employers including General Mills, Medtronic, and Target in Minnesota. President Helen Darling says as long as the new federal regulations are reasonable, there won't be a problem.

"The key is what's included and that's what's important," Darling said. "One of the things that happens when something is legislated by others who don't necessarily understand the evidence or not concerned about what things cost because they're not paying the cost is to say well everybody should have fill in the blank."

Many politicians have promoted prevention as a way to control health care costs. But two years ago, the New England Journal of Medicine reported that many prevention procedures don't always save money.

Some prevention measures are more cost effective than others -- vaccines and stop-smoking programs, for example, said Rutgers University health economist Louise Russell, but most cost more than they save.

"An awful lot of prevention involves screening people who don't have whatever it is," Russell said. "So you screen them, they don't have it, you move on, maybe in 5 years you screen them again they still don't have it."

Russell said it's misleading to sell prevention as a way to control health care costs but, she said, that really shouldn't be the goal. The real value of effective prevention is in keeping people healthier and living longer.

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