PUBLIC PREFERENCES FOR PREVENTION VERSUS CURE - WHAT IF AN OUNCE OF PREVENTION IS WORTH ONLY AN OUNCE OF CURE

Background. The belief that small preventive efforts bring large benef its may explain why many people say they value prevention above all ot her types of health care. However, it often takes a great deal of prev entive medicine to prevent a bad outcome. This study explores whether people value prevention or cure more when each brings the same magnitu de of benefit and examines whether preferences for prevention or cure vary according to the severity of the disability of the patients who c an receive the preventive or curative intervention. Methods. 289 prosp ective jurors were presented with a policy dilemma involving how best to allocate funds to benefit people with varying levels of disability. Each project was said to influence the functional ability of 100 nurs ing home residents, either by improving their level of function or by preventing their level of function from declining. Results. When given a choice between preventive and curative interventions, more subjects preferred the preventive intervention (37% vs 21%, p = 0.002). Howeve r, when the strength of people's preferences was taken into account, t he preference for preventive interventions was not statistically signi ficant (p = 0.135). With both preventive and curative interventions, t he subjects preferred helping patients with more severe disabilities ( p < 0.005 for both comparisons). This preference for helping more seve rely disabled patients did not differ for prevention and cure (p = 0.6 63). Conclusion. When the magnitude of benefit was held constant, the subjects slightly preferred prevention over cure. In addition, they pr eferred directing limited resources toward those with greater disabili ties, regardless of whether those resources were targeted toward preve ntion or cure. These findings suggest that previously stated preferenc es for prevention over cure may result from a belief that small effort s at prevention will be repaid by large reductions in the later need f or cure.