Why Preventive Care Lowers Health Care Costs

National Health Care Plans Must Cover Preventive Care

Child with doctor
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Preventive care is any medical service that protects against or reduces the likelihood of health emergencies. It is covered under the Affordable Care Act and helps keeps health care costs low.

Learn more about what counts as preventative care and how this impacts your health care and insurance costs.

What Is Preventative Care?

Preventative care is health care that prevents disease, injury, or illness, rather than treating a condition that has already become catastrophic or acute. The goal of preventive care is to help people stay healthy.

Preventative care can include:

  • Doctor visits, such as annual physicals, well-child visits, annual gynecological care, and dental cleanings
  • Immunizations
  • Contraception
  • Allergy medications
  • Insulin
  • Colonoscopies and mammograms
  • Screenings, such as tests for skin cancer, high blood pressure, and high cholesterol

Preventive care also keeps people productive and active, enabling them to keep earning well into their senior years. Health problems forced 35% of retired people into early retirement before they were financially ready.

Access to affordable preventative care can help lower these numbers.

Why Does Preventative Care Matter?

Preventive care helps lower health care costs in America by preventing or treating diseases before they require emergency room care. 

Hospital care is very expensive, making up one-third of all health care costs in America. In 2010, 21.4% of adults had one or more emergency room visits. By 2017, that had decreased to 18.6%.

Adults who do not have affordable access to preventative care are more likely to use the emergency room as their primary care physician.

In 2014, 7.0% of adults aged 18-64 went because they had no other place to go for health care, regardless of health insurance status, while 77% went to the ER due to the seriousness of the problem (this includes those who were sent by their doctor). And 15.4% of uninsured adults are more likely to use the emergency room due to lack of access to other providers.

The cost of emergency room care for the uninsured can be extremely high. Hospitals are required to provide care, even if the patient cannot afford to pay for the services they need.

Because the hospital must recover these costs from somewhere, they get shifted to health insurance premiums and to Medicaid. This increases the costs of healthcare for everyone.

Impact of Preventative Care on Health Care Costs

Four out of the five leading causes of death are caused by chronic diseases that are either preventable or likely to be manageable with regular access to health care:

  • Heart disease
  • Cancer
  • Chronic lower respiratory disease
  • Stroke 

Heart disease and strokes are primarily caused by poor nutrition and obesity. Lung cancer, the most common type, is primarily caused by smoking and genetic factors. Obesity is also a risk factor for other common forms of cancer.

Even before they reach emergency room status, these chronic diseases are expensive to treat. In the United States, 90% of the $3.5 trillion in annual health care expenditures are for people with chronic and mental health conditions.

Patients without preventative care or prescription coverage can't afford the treatments, screenings, doctor visits, or medications needed to manage these conditions. When they cut back, they wind up in the emergency room with heart attacks, strokes, and other complications.

When patients have regular access to affordable preventative care, their chronic conditions are more likely to be discovered and managed. This lowers the likelihood of both emergency room visits and more expensive treatments for diseases that have progressed past regular management.

When these decrease, the overall cost of healthcare decreases for everyone because hospitals are not trying to cover the cost of treating uninsured patients.

The ACA Relies on Preventive Care to Cut Costs

The Affordable Care Act (also known as the ACA or Obamacare) requires insurance companies, Medicare, and Medicaid to provide preventive care services for free. All procedures recommended by the U.S. Preventive Services Task Force have no copay and are included as part of the 10 essential benefits.

The strategy appears to be working. In 2018, a Health Affairs study found states that expanded Medicaid saw a 40% increase in the number of prescriptions filled for diabetes drugs. States that didn’t expand Medicaid expansion saw no increase.

The ACA's preventive care provisions include:

  • Preventative and wellness visits
  • Maternity and newborn care
  • Mental and behavioral health treatment
  • Prescription drug benefits
  • Lab tests that diagnose disease

Maternity and Newborn Care

This includes well-woman visits, domestic violence screening, and support for breastfeeding equipment and contraception.

This is considered cost-saving preventive care because it's cheaper to provide good care for pregnant women and newborns than to treat pregnancy complications or preventable premature births.

Mental and Behavioral Health Treatment

Many homeless people in America have untreated mental and behavioral health problems.

As of 2020, 567,715 people were homeless on any given night in the U.S. Of these, 250,000 or 45% had mental illness. Left untreated, these conditions increase the need for expensive emergency rooms, police action, and jails.

A homeless person visits the emergency department an average of 5 times each year, costing taxpayers an average of $18,500.

Diagnostic Lab Tests

These must be covered 100% if diagnostic as they are considered preventive. If you've already been diagnosed with a disease, your regular copays and deductibles will apply.

Pediatric Care

Dental and vision care must be covered for children.

Prescription Drugs

All plans listed on the exchanges will include coverage of at least one drug in every category in the U.S. Pharmacopeia. Whatever you pay out-of-pocket for drugs will also count toward your deductible. This is not true though for all insurance plans prior to the ACA.

Article Sources

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  3. Centers for Disease Control and Prevention. "Table 36. Emergency Department Visits Within the Past 12 Months Among Adults Age 18 and Over," Page 1. Accessed Nov. 29, 2020.

  4. Centers for Disease Control and Prevention. “Reasons for Emergency Room Use Among U.S. Adults Aged 18–64: National Health Interview Survey, 2013 and 2014,” Pages 5-6. Accessed Nov. 29, 2020.

  5. Centers for Disease Control. "Leading Causes of Death - Males - All Races and Origins - United States, 2017." Accessed Nov. 29, 2020.

  6. Centers for Disease Control and Prevention. "Potentially Preventable Deaths Among the Five Leading Causes of Death — United States, 2010 and 2014." Accessed Nov. 29, 2020.

  7. Centers for Disease Control and Prevention. "Health and Economic Costs of Chronic Diseases." Accessed Nov. 29, 2020.

  8. Health Affairs. “Medicaid Eligibility Expansions May Address Gaps in Access to Diabetes Medications.” Accessed Nov. 29, 2020.

  9. National Alliance to End Homelessness. "State of Homelessness: 2020 Edition." Accessed Nov. 29, 2020.

  10. The Brain & Behavior Research Foundation. "Homelessness and Mental Illness: A Challenge to Our Society." Accessed Nov. 29, 2020.

  11. US National Library of Medicine. "The Business Case for Ending Homelessness: Having a Home Improves Health, Reduces Healthcare Utilization and Costs." Accessed Nov. 29, 2020.