Preventive health care: Why privately funded programs are reluctant to fund it

Posted on May 8, 2023 in Health Policy Context

Source: — Authors: , – Opinion/Contributors
May 6, 2023.   By Liju Mathew, Peter Zhang, Contributors

As Ontario contemplates the role of privatized health care, the continued investment of preventative health services must remain a priority. Preventive care aims to prevent health issues before they manifest and includes services like vaccines and screenings for cancer, which affect millions of people and incur significant costs to the health care system.

In a privately funded payer model, preventative services directly benefit patients who are responsible for paying health care costs themselves. However, the upfront costs associated with preventative health services are often perceived by patients to be unnecessary.

This is especially the case for patients who face financial constraints or for presently healthy patients who feel that they are at low risk for future health complications. For this reason, many patients will fail to proactively seek preventative health services within a privately funded health care system.

Private insurance programs will also find little motivation to fund preventative health services. The insurer could see the cost for prevention today but not its benefits over the lifetime of the patient as there is a risk the consumer changes insurance providers. Unless mandated, private insurers may neglect the funding of preventative care services.

This is important to consider, especially when government mandates are not always reliable. In fact, a recent ruling in a federal United States courtroom reversed a policy mandating insurers to provide certain preventive health services at no cost.

Within a publicly funded care model, there is a vested interest to mandate and fund preventative health measures as government payers are accountable for sustainable health care budgets. Recognizing that early prevention can reduce costs down the road, governments are more willing to pay for screening services for patients at risk.

We see this with preventative measures such as vaccination. In Canada, the HPV vaccine is publicly funded and there is a wealth of evidence demonstrating that the resulting reduction in cervical cancer is cost-effective. Although access to HPV vaccines is only one contributing factor, we have seen a 45 per cent decrease in cervical cancer rates in Canada since 1984. Other services such as mammography screening have been shown to reduce breast cancer deaths by 25 per cent..

However, one drawback of broad screening services is its inefficient execution. Broad policies can create an unnecessary burden on health care capacity when testing eligible patients who have a low individual risk, or missing ineligible patients who carry a high individual risk.

For this reason, the ability to predict the individual risk of patients using artificial intelligence is incredibly exciting in the health care space. Investments to enhance preventative care through such innovations is essential.

However, until these innovations come into the market, a broadly implemented preventative health program continues to have a critical role in saving patient lives and reducing long-term payer costs.

Should preventative health measures become ignored, the rise of preventable disease will carry enormous patient and cost burdens where ultimately — everyone pays the price.

Liju Mathew is a pharmaceutical industry executive. Views, thoughts, and opinions expressed belong and reflect solely the author. Peter Zhang is a hospital pharmacist who writes about health care strategy and innovation.

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