Congressional Budget Office Finds Preventive, Wellness Care Could Drive Up Health Care Costs

By Staff Report

Aug. 11, 2009

The Congressional Budget Office said that federal investment in prevention and wellness programs could actually drive up costs rather than reduce them, and potentially overstep programs already in place in Medicare and private health plans.

Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall,” CBO Director Douglas Elmendorf wrote in a blog entry posted Sunday, August 9.

Preventive services include medical procedures to test for certain types of cancer, cholesterol management and vaccines, while wellness programs include weight management programs, dietary advice and smoking cessation directions.

In each case, the CBO said that even though it plans to study the topic further, it’s hard-pressed to show what’s known as “scorable” long-term savings. The issue has long frustrated lawmakers, who have banked on parlaying such programs into future health care savings.

Legislation in the House and Senate meant to reshape the health care system include measures to nudge Americans into healthier lifestyles, and members of Congress have tried to count those programs toward an overall lowering of health care costs.

But researchers who have studied preventive care “generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness,” the CBO states.

Nevertheless, the CBO said that just because spending on prevention adds to the nation’s total health care tab, it’s not necessarily a bad investment.

“Experts have concluded that a large fraction of preventive care adds to spending but should be deemed ‘cost-effective,’ meaning that it provides clinical benefits that justify those added costs,” Elmendorf writes.

The CBO letter was sent to senior members of the Energy and Commerce Committee.

Filed by Matthew DoBias of Modern Healthcare, a sister publication of Workforce Management. To comment, e-mail

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