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Prevention: Not a Panacea for National Health Budgets-Reply
George A. Gellert, MD, MPH, MPA
Arizona Department of Health Services Phoenix
Arch Fam Med. 1993;2(10):1021-1022.
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In reply
I appreciate Dr Dodge's kind remarks and essentially share his perspective. While I agree that more sophisticated and quantitative evaluation data are needed to articulate precisely where primary prevention strategies are most cost-effective, I do not share the view that this approach is "dubious." A central issue requiring continual reemphasis is that what the nation faces is not an intellectual choice of one approach over another in reconstituting the health care system. Actually, there is little choice—if late-stage morbidity expenditures are not reduced, it will hardly be possible to provide adequate primary care and sustain the technological and research infrastructure for state-of-the-art tertiary care. The point of intervention and chief focus of the health care system must be shifted to earlier in the causal emergence of disease to reduce the burden of late-stage morbidity, or at least to hold it steady as the population ages. Although technological advances such as
. . . [Full Text PDF of this Article]
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