The economics of prevention: a critique

A recent claim that "few preventive programmes, if any, reduce medical expenditures" is critically reviewed with specific reference to the health value of regular exercise. It is argued that a focus upon medical expenditures biases the argument in favour of acute care by neglecting much of the investment in research, training and construction, and ignoring differences in the quality of life between fit and marginally healthy individuals. By focussing on a specific clinical condition, the widespread benefits of exercise are also overlooked, and by equating costs with the consumer price index, errors from differential inflation are ignored. Discounting of benefits weighs heavily against prevention, but is an inappropriate tactic in a steady-state situation. Likewise, the levying of incidental medical charges for an extended lifespan is inappropriate when the individual concerned is also contributing to society. Limited recruitment and poor adherence are the main current weaknesses of preventive medicine, but their impact should be reduced when a preventive philosophy becomes the norm for both the patient and his or her medical adviser. The collection of appropriate and unbiased estimates of costs and benefits is an important first step towards this objective.