Does increased preventive care access reduce health costs?
It has been perceived that improved access to preventive care will decrease the need for intensive care, and in turn, the healthcare expenditure associated with the latter. For example, patients will have more access to primary care doctors, will be better screened and treated early, and will better and more timely managed in general, thus reducing use of emergency rooms and need for invasive care. As a matter of fact, that is neither necessarily true nor necessarily a tragedy. However, it may be used as an argument against the success of the Affordable Care Act by those who believe that the goal of Obamacare was to cut healthcare costs.
The truth is that the purpose of the healthcare reform is to expand access while curbing expenditure over time was a secondary objective; it might be a bit of a fallacy to assume that one should follow the other in equal measure, though. As it turns out, healthcare can be made either accessible or cheap, but not both at the same time, especially when quality also is a factor. In other words, cheaper and accessible care would be shoddy, and quality care that is also accessible must needs be costly.
In addition to that, the aforementioned cost-reducers do not work as expected in practice as they might in theory. The emergency room, for instance, is not just the last refuge of the uninsured. The main reason that some people resort to the ER even for minor issues has nothing to do with insurance -or lack thereof- and everything to do with convenience; a state of affairs that Obamacare can do little to improve or worsen. What’s more, certain studies have suggested that increased healthcare coverage such as Medicaid actually increases ER use rather than decrease it.
Similarly, there may be a link between improved access to care and an increased use of more invasive procedures. Michigan researchers comparing the prevalence of surgery in Massachusetts, New Jersey and New York before and after the first went to universal insurance in 2007 showed a 9% increase in discretionary operations and a 4.5% increase in non-discretionary ones associated with expanded insurance. Generally speaking, the notion that prevention results in cost-cutting is more perception than reality, and can hardly be chalked up to the Affordable Care Act being a failure -though it isn’t perfect by any means, as exemplified by its less than stellar online debut.
On the contrary, it is only normal that increased access equals increased spending; after all, getting proper care to as many people as possible is indeed expensive. Of course that something should be done about the U.S. healthcare system raking first in cost and last in just about every other category, but improving access to care does address another problem, which is that of prolonged waiting lists. In the meantime it’s important to remember that good, cheap, and accessible care will probably remain a utopia than become a reality any time soon.