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Flawed analysis may result in preventable loss of life

Posted by plosmedicine on 31 Mar 2009 at 00:20 GMT

Author: Laura Rosen
Position: Lecturer
Institution: Dept. of Health Promotion, School of Public Health, Tel Aviv University
Submitted Date: February 23, 2008
Published Date: February 25, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

To the Editor:
I read with interest your recent article showing that prevention of obesity and tobacco use is likely to increase lifetime health expenditures.
Because prevention of tobacco use and obesity both lengthen life, this finding is not surprising. Lifetime health expenses are cumulative, and therefore by definition monotonically increasing over time for a given individual.
Surprisingly, the article makes no mention of patient contributions to the health care system. Those contributions, which are also monotonically increasing, take place directly through client payments, payments from employers, and payments from insurers, and indirectly through increased participation in the work force and increased cumulative taxation.
By including patient expenditures while excluding any mention of patient revenues, the analysis presents a skewed picture of the true financial effects of prevention on the health care system. Sadly, this may deter policy makers from investing in prevention, and thus cause unnecessary – and entirely predictable - loss of life.


Laura J. Rosen, PhD

Dept. of Health Promotion
School of Public Health
Sackler Faculty of Medicine
Tel Aviv University

No competing interests declared.