title: Why behavioral and environmental interventions are needed to improve health at lower cost.
abstract: We used a dynamic simulation model of the US health system to test three proposed strategies to reduce deaths and improve the cost-effectiveness of interventions: expanding health insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. We found that each alone could save lives and provide good economic value, but they are likely to be more effective in combination. Although coverage and care save lives quickly, they tend to increase costs. The impact of protection grows more gradually, but it is a critical ingredient over time for lowering both the number of deaths and reducing costs. Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent.
authors.affiliation: Centers for Disease Control and Prevention, in Atlanta, Georgia, USA. bmilstein@cdc.gov
authors.forename: Bobby
authors.initials: B
authors.lastname: Milstein
authors.forename: Jack
authors.initials: J
authors.lastname: Homer
authors.forename: Peter
authors.initials: P
authors.lastname: Briss
authors.forename: Deron
authors.initials: D
authors.lastname: Burton
authors.forename: Terry
authors.initials: T
authors.lastname: Pechacek
mesh_terms: D002908:Chronic Disease / Q000191:economics / Q000401:mortality; D003198:Computer Simulation; D003247:Conservation of Natural Resources / Q000191:economics / Q000639:trends; D003362:Cost-Benefit Analysis / Q000639:trends; D004782:Environmental Health / Q000191:economics*; D015438:Health Behavior; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends; D008962:Models, Theoretical; D011314:Preventive Health Services / Q000191:economics / Q000639:trends; D058996:Quality Improvement / Q000191:economics / Q000639:trends; D015996:Survival Rate; D014481:United States