The Importance of Predictive and Preventive Health Care

Archived Topic Box from the 2005 Fifth Annual Benchmark Report

Health care costs consume a significant and growing portion of B.C.'s public revenues – a full 43% of the total provincial budget in 2005/2006 at a cost of $11.6* billion. These costs, have increased twice as fast as the provincial economy in recent years, and show no sign of diminishing in the near future. In light of this growing public cost, enhanced attention is being paid to approaches that may prove valuable in reducing health care costs while, at the same time, providing British Columbians with improved health care outcomes.

Techniques for predicting and preventing illness, injury and disease are by no means new. Predictive health care is the identification of factors that are likely to contribute to disease or illness in certain populations or individuals. Predictive methods have been used in various forms at the public policy level as well as by private insurers for years. Based on predictive methods the health care system has begun to better understand what factors may contribute to illness, and look at approaches to illness prevention. Prevention, the attempt to ensure disease and illness do not occur rather than simply treating symptoms, also has a variety of forms and has seen significant growth over the last century with the introduction of various public health and safety policies, public immunization programs, physical education in schools, and workplace safety initiatives (among others). But both predictive and preventative health care are currently showing signs of significant promise in the ongoing challenge to ensure that British Columbians live healthier lives, while simultaneously reducing the burden on the health care system.

With the ActNow campaign, and various complimentary measures, BC is hoping to address five common risk factors – physical inactivity, tobacco use, obesity, poor nutrition, and alcohol use during pregnancy – in an effort to reduce a number of serious yet frequently preventable chronic illnesses including cancer and cardiovascular disease. With 30 percent of the healthcare budget consumed by 5 percent of the population with multiple chronic illnesses, attempting to avoid these conditions, rather than treat them once they have occurred, is healthier for both the patient and the system.

While prevention can be enhanced through addressing these common health risk factors there are other actions which could prove useful. Increasingly, attention is being drawn to the possible impacts of environmental factors on British Columbians' health. Ensuring that British Columbians' food, drinking water and air resources are protected is important to reducing treatment costs for disease and illness. Towards this end, ongoing measurement and monitoring of BC's air quality, UV indexes, and exposure to toxins such as lead and mercury will be essential to ensuring a healthy populace and a manageable health care burden.

Another area where preventive health can have a positive impact on both outcomes and health care costs is the area of inadequate and inappropriate healthcare. The misuse, over-use (excessive prescribing of antibiotics and other drugs or treatments) and under-use (the inadequate treatment of chronic disease) of health care procedures and treatments are gaining attention. The financial and human costs of such errors and omissions in medical treatment are profound – and potentially avoidable.

Prediction of illness has started to take on a new scope based on scientific developments in genetics. While this research is still in its infancy, some new tests can predict the health risks of individuals, as opposed to groups at risk, by detecting genetic mutation, predisposition, and markers. As technology advances, health care systems in BC and beyond will have to weigh the costs of testing individuals versus the subsequent costs of monitoring, prevention and treatment. The effects of testing on health care costs will depend upon the test's accuracy, the degree to which genetic markers are true indications of disease risks, and how individuals react to the results.

Sources: BC Ministry of Health, Health Care Today and Tomorrow and (2004), Toward Better Health Care for British Columbians and Prevention and Wellness Planning; notes from staff researcher's discussions with Dr. Ray Copes, BC Centre for Disease Control and Dr. John Millar, Population Health, Provincial Health Services Authority; Ontario Ministry of Health (2002), Predictive Genetic Tests and Health Care Costs.

Note: *These numbers do not match those in the "Health Care Spending and Health Outcomes" due to an inflation adjustment and the fact that these data are more up-to-date than those presented by the Canadian Institute for Health Information (CIHI).