Louise Russell, a professor in the Rutgers Department of Economics, School of Arts and Sciences, chairs the Health Care Policy Division at the Institute for Health, Health Care Policy and Aging Research on the Rutgers–New Brunswick Campus. Before arriving at Rutgers in 1987, she was a senior fellow at the Brookings Institution in Washington, D.C. While at Brookings Russell published several books about health and medical spending, including her best known, Is Prevention Better than Cure? In 2007, the National Coalition on Health Care asked Russell to update the research presented in that book, and 20 years later, Russell’s conclusion was the same: prevention costs more than it saves. An elected member of the Institute of Medicine (IOM) of the National Academy of Sciences, Russell has served on several IOM committees, including the National Cancer Policy Board. She co-chaired the U.S. Public Health Service Panel on Cost-Effectiveness in Health and Medicine, which published recommendations for improving the quality and comparability of cost-effectiveness studies in 1996. Russell currently serves as an associate editor of the journal Medical Decision Making.

FOCUS: The general reasoning is that the more money spent on prevention, the greater the savings in treatment. What, in your analysis, is counterintuitive to this?

Russell: Although polls show that many Americans believe spending more on preventive care will help bring health care costs under control, cost-effectiveness analyses show that the opposite is actually true. By reviewing studies done over the years, I found a consistent pattern showing that various forms of prevention – including screenings; treatment of risk factors, such as elevated blood pressure or cholesterol; and doctor advice and programs – usually increase medical spending rather than reduce it. To get the benefit of prevention, you have to treat a lot of people, often for a long time. The costs add up, while only some people ultimately experience savings. While there are savings in treatment, there usually aren’t enough to overcome the expenditures for the preventive intervention. People tend to focus on the individual who ultimately benefits, or would benefit, from the prevention. But they’re forgetting all the people at risk for disease who receive prevention, and when those costs are added up over all the years, the total cost usually exceeds any treatment savings.

FOCUS: How does your research analysis tie into the current health care reform debate?

Russell: The consensus is that the United States spends too much on treatment and not enough on prevention. I’ve compared the costs and health outcomes of preventing disease, or treating it later. This information will be useful to lawmakers in determining that spending more on prevention won’t save money, and that to reduce costs they’ll need to look elsewhere.

It also will help them set priorities for prevention. While some preventive methods buy many years of healthy life, others don’t. And we want to spend our money so we can produce as much health as possible. For example, according to cost-effectiveness analysis, flu shots for people over 65 are very cost-effective, but annual Pap smears – as opposed to screening less often – buy very few years of good health. The result is we spend in a very scattershot way. We need to pay more attention to whether we’re doing the most valuable and effective interventions first and leaving the less effective things for later.

FOCUS: Have you and your research analysis faced much controversy?

Russell: When I wrote Is Prevention Better than Cure? about 20 years ago, its findings were controversial. The evidence was there and undeniable. But people didn’t want to hear it, and many were angry with me. Now, I think, more people are listening and want to revisit the research. Last year, when I participated in a conference in Washington, D.C., for the American Enterprise Institute, an audience member – the dean of a major medical school – approached me and said, “When I read your book 20 years ago, I thought you were nuts. But I’ve come around.”

FOCUS: How does your work as an economics professor affect your work at Rutgers’ Institute for Health, Health Care Policy and Aging Research?

Russell:  As an economist, I have a natural tendency to analyze the costs and benefits of most decisions, and cost-effectiveness analysis is simply a framework for looking at medical interventions in that way. I also enjoy the mathematical nature of that kind of research. What I like best about cost-effectiveness analysis is that it brings together so many perspectives. I need to learn about the medical care involved, the statistical methods used in the research, how to measure the costs, and other issues. It’s a great field because it allows you to look at many different aspects, and yet at the end of the day, bring them all back to a focus.

FOCUS: Who and what has been your inspiration for the work you do?

Russell: My very first job was in the Department of Health and Human Services, where I produced reports about the Medicare program and learned a lot about the economics of medical care. Under the supervision of a well-known health economist, Dorothy Rice, I became very curious about the increase in medical costs. I wondered exactly what the money was being spent on, which inspired me to write my first book, which was on technology and hospitals, and later led to my interest in cost-effectiveness. Then, when I served as a member of the first U.S. Preventive Services Task Force in the mid-80s, I was in a room filled with doctors who thought about these issues all the time, and it was a wonderful education and introduction for me. Serving on the Panel on Cost-Effectiveness in Health and Medicine in the 1990s was also a wonderful experience. The panel brought together some of the best people in the health field, economists and others, to consider how to improve and standardize cost-effectiveness analysis and the discussions were always interesting.