Penny wise...

...pound foolish. It's not just insurance companies who follow this model. In some defense - some small wee bit of defense - of such policies, the financial wisdom of preventative care and education is not easy to see. Possibly for some, it feels like speculation, like placing a bet. Good odds or not, they are too queasy with the idea of spending some money now to save a whole lot of money later.

From The Boston Globe
Health support for poor to take hit
'08 budget cuts care of chronic ills
By Alice Dembner, Globe Staff
June 19, 2007

HOLYOKE -- A program that has improved the health of low-income patients with chronic illnesses faces deep funding cuts in the pending state budget, even though top state officials touted similar disease management strategies just a month ago as a crucial way to improve healthcare quality and cut costs.

The 2008 budget, now being hammered out in a legislative conference committee, is likely to contain less than one-third of the $2.6 million that the statewide CenterCare program received this year to pay for a broad range of health education and support services at community health centers.

In Holyoke, where diabetes strikes hard and often, the program has helped hundreds of patients at a community health center adopt healthier lifestyles and reduce their blood sugar levels, an improvement that could eventually cut their risk of serious complications nearly in half. Diabetics are offered exercise classes, instruction about the disease, home visits by community health workers, one-on-one sessions with a nutritionist, and drop-in sessions that teach healthy eating.

"I lost 63 pounds and I'm controlling my sugar," said Iris M. Santiago, a patient in Holyoke. "They've helped a lot of people's lives."

The proposed funding cuts threaten the Holyoke program, which has been recognized as a national model, as well as similar efforts at 29 other community health centers statewide. CenterCare this year paid for disease management services for only half the low-income patients eligible across the state -- about 5,000 -- according to the Massachusetts League of Community Health Centers. The program helps patients with asthma, cancer, heart disease, and depression, in addition to diabetes.
...
State Senator Steven C. Panagiotakos , chairman of the Ways and Means Committee, said the Senate reduced funding for CenterCare because "we are able to address many of the preventative care and disease management needs" through the state's health insurance initiative because many of the program's uninsured clients will get coverage.

But community health center officials say their efforts go far beyond that funded by most insurers, because their patients need more support to overcome the additional barriers to good health presented by poverty and low literacy.

CenterCare was established in 1988 as a managed care insurance program for low-income patients but never got off the ground. It then funded care for the uninsured at community health centers, and most recently has been paying for disease management, according to the community health centers league.
...
Since the program started at the health center in 2003 the average blood sugar levels of diabetic patients -- called hemoglobin A1c -- have dropped from 8.4 to 7.5, according to Dawn Heffernan, who manages Holyoke's program.
(presumably this last bit refers to patients in the program or some subset of them who consented to sharing lab values)