Faculty Articles


Healthcare Spending and Prevention within the Affordable Care Act: Contrasting the Public Health and Medical Models of Prevention



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Palgrave MacMillan

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During the 2012 election season, some saw the election as a referendum on the Patient Protection and Affordable Care Act (ACA) as much as it was an election between presidential candidates. However, in addition to the controversy surrounding the ACA is the contentious role prevention plays within the law. It is common knowledge that the Act seeks to improve access to care, enhance the quality of care provided in the US, and reduce healthcare spending, but one of the ACA’s important and contested methods for reducing healthcare spending is the use of preventive interventions. There are noteworthy disagreements surrounding potential healthcare cost savings associated with prevention, let alone what activities constitute prevention. These disagreements involve alternative models within the prevention policy community: the public health model and the medical model. Therefore, the role of prevention within the ACA provides substantive examples of the differences between the public health and medical models of prevention and of the financial consequences resulting from the models’ policy approaches. It also demonstrates the ways competing models of thought amongst members of a policy community impact policy discussions, decisions, and responses. Both public health and medical models of prevention have the opportunity to make significant contributions to improved quality of health outcomes but with different consequences for healthcare spending. Policymakers, administrators, and researchers can improve the way the nation designs and manages healthcare policy by acknowledging the differences between the alternative models of prevention and by synthesizing them into optimally effective and efficient approaches to health and health policy.


Medical Specialties | Medicine and Health Sciences | Osteopathic Medicine and Osteopathy

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