The case for targeted preventive healthcare

Australians travelling overseas and needing medical treatment will be familiar with the leading-edge quality of our health system – from our hospitals, pharmaceutical benefits system and pathology labs – compared to many other nations. Yet it turns out Australia is decidedly average when it comes to spending on preventive health compared to other OECD nations.

But according to an article by The New England Journal of Medicine (NEJM) from 2008, the economic case for preventive healthcare spending is by no means clear cut. In some cases – like flu vaccinations or colonoscopies – there is a health benefit and cost saving, in other cases the cost-benefit is negligible or poor.

In the first phase of preventive medicine, proponents suggested better health and economic outcomes were possible through early detection of conditions, only to have detractors point out the enormous scope of the enterprise, warning about misleading statements about its supposed benefits.

Up like a rocket, down like a stick: the case for spending on preventive healthcare seemed to be knocked into a cocked hat, a medical cul-de-sac. Or perhaps not.

A recent 2017 Australian study by La Trobe University’s Department of Public Health, suggests that preventive medicine does indeed have an important role to play in the Australian health landscape, stating ‘There is clear evidence that many preventive health interventions are cost-effective.’

Like the NEJM article, the La Trobe study’s authors accept that spending on preventive healthcare is not a panacea for all cases and needs to be strategically targeted, but the benefits of doing so could be significant.

Referencing the 2010 Assessing Cost-Effectiveness (ACE) in Prevention study by the University of Queensland and Deakin University – which looks at the benefits of campaigns around tobacco, alcohol, unhealthy foods, gastric banding, and a raft of other measures – the La Trobe study authors state ‘the evidence considered suggests a strong case can be made for increasing spending on preventive health.’

As Michael Thorn of the Foundation for Alcohol Research and Education (FARE) points out, a third of all chronic diseases are preventable and can be traced back to four lifestyle factors: alcohol use, tobacco use, physical inactivity, and poor nutrition. Preventive medicine in those areas, from education to pathology tests, would make sense.

One area of health that certainly would benefit from preventive healthcare spending is on type 2 diabetes. Indeed the case for a national roll-out of the relatively new HbA1c test – which measures glycated haemoglobin in the body – is strong.

In a 2016 trial program run at Mt Druitt Hospital in Blacktown, anyone over 18 presenting to the Emergency Department for blood tests were also given the HbA1c test. The findings were striking.

In the two years from mid-2016 to mid-2018, 48,000 samples were taken, with 47 per cent of those tested presenting with diabetes or prediabetes.

While Blacktown is in the electorate of Chifley, the seat with the highest incidence of diabetes in Australia at 7.8 per cent, the residence of Chifley are not exactly outliers. The national diabetes average is 6 per cent, with 1.2 million Australians living with diagnosed diabetes and a further 500,000 thought to be living with undiagnosed diabetes.

According to the the Centre for International Economics (CIE) 2018 report the prognosis for diabetes in the future is alarming, with 3.5 million Australians projected to be living with diabetes by 2030.

A person can have diabetes for seven years before it symptoms are evident, during which time it’s doing damage to the body. Fortunately, the Centre for International Economics (CIE) 2018 report states that if diabetes is detected and treated early before macrovascular complications ensue, it can more than halve treatment costs.

Given the direct costs of diabetes to the health budget are $1.7 billion a year, with indirect costs to the economy as high as $14 billion, a preventive health program that can significantly cut treatment costs seems like an absolute no brainer.

While it’s not feasible to test every Australian for every condition, that does not preclude smart, targeted testing for specific conditions, such as the bowel screening test for those aged 50-74, diabetes testing for those with a waistline over 102cms, or cervical testing for women with human papillomavirus (HPV), immune deficiency and other risk factors.

Government spending on pathology services in Australia represents just 2.7 per cent of the health budget, while 70 per cent of medical treatment decisions rely on pathology.

With Medicare spending forecast to climb over 25 per cent by 2027-28 from $855 to $1,071 per person that puts even more of a premium on finding ways to reduce health costs by way of preventative medicine, of which pathology testing is central.

So rather than throw the baby out with bathwater, we suggest some targeted funding for targeted testing campaigns that can deliver those health and economic outcomes we all hope for.