Prevention is OK – if within budget

I was reading a very interesting article on Medscape this week which makes the point that preventative medicine is quite likely the only healthcare area in which cost is the prime driver.

Holding preventative medicine to a cost standard is something not practiced in disease care where a cure is the prime driver irrespective of price. Hence there are many government subsidised medical procedures, pharmaceuticals, screening programs and so on of questionable evidence base or cost/benefit value but are based in the disease care model so are less questioned.

Any suggestion of a preventative program is immediately costed and if not meeting budget targets, discarded. This may be a bit strong, but you get the idea.

I am reminded of a meeting I attended at the local private hospital some ten years ago where the Director was outlining their increase in medical specialists based at their brand spanking new specialist centre attached to the hospital. ‘Four cardiologists, two orthopaedic surgeons, two ENT, three physicians…’ and on he went proudly.

Later I sidled up and asked how many preventative medicine specialists they had recruited? He look at me incredulous and said ‘None, of course – they keep people out of hospital. We want doctors who admit patients.’ The business model of private hospitals is based on people getting ill or injured, and while they can’t actually promote this, they can certainly pave the way to their admission desk.

It makes you think.

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