• Whereas the cost of prenatal care is only a couple of hundred dollars, the average cost of medical care for a premature baby is nearly $20,000 more than the cost of a normal birth.
• Whereas vaccinations for measles, mumps and rubella cost about $20 each, the average cost for hospitalization to treat those diseases runs about $21,000.
• Whereas 2,175 Dallas children contracted measles in 1989 for a total cost of $3.4 million, immunizations for them would have cost only $3,700.

"There is serious doubt that free preventive care will either expand access or save money."

First, does free care increase access? Although nationally only a little more than half of all children are immunized by the age of two, more than 95 percent are fully immunized by age five so they can enter school. Is the difference between the vaccination rate at ages two and five primarily due to the barrier of price? The evidence suggests otherwise.

Take Massachusetts, the state with the nationís oldest free immunization program. Vaccinations there are available to all children without charge, regardless of the parentsí financial means. Are all Massachusetts children immunized? Hardly. While the national average is about 58 percent of children properly immunized by the age of two, the Massachusetts rate is 62 percent. The 11 other states with free childhood immunization programs also experience only marginally better rates.

Second, does preventive care save money? Careful studies show that, in general, preventive medicine raises rather than lowers overall health care costs. Preventive medicine is "economical" only when special at-risk groups are targeted. Giving preventive services to the entire population usually costs more than any savings from the early detection of disease. For example, if every American were provided with an MRI scan, as many as 85,000 early-stage brain tumors or aneurysms might be detected. In many of these cases, early detection would reduce the total cost of care and, in some cases, it would save lives. But at $1,000 per MRI scan, the total cost would be $260 billion - more than one-fourth of the total national spending on health care - for one procedure.

This does not mean that preventive care is wasteful. Diagnostic tests that show freedom from disease relieve patientsí anxiety and reassure them of good health. Thus, for the most part, preventive care is like a consumer good that creates benefits in return for a cost. It is not like an investment good that promises a positive rate of economic return.

Good Idea: Target Free Services to the Neediest.

"Targeting free services to the neediest mothers and children would be more efficient and cost-effective."

Bad Idea: Eliminate Deductibles for Preventive Services.

Although many who advocate expanding preventive care are motivated by humanitarian concerns, creating subsidized or free programs for all patients would absorb scarce dollars - with little or no net benefit. A much better approach is to allow those who can afford preventive care to weigh its value against other uses of their money and to target government money to those who cannot afford the care.

Intuitively, it would seem that diagnosing illnesses before patients notice symptoms would benefit their health, and more follow-up care would reduce the need for expensive medical interventions later on. But recent research shows that these assumptions may not hold true.

Medical researchers studied 1,396 patients in nine veterans' hospitals with chronic illnesses that require frequent rehospitalization and emergency care -- diabetes mellitus, obstructive pulmonary disease and congestive heart failure. Some patients were given six months of intensive follow-up care by primary physicians and nurses, while others received normal follow-up care.

The intensive care included a visit by the primary care physician two days before discharge, a follow-up telephone call from a nurse within two days after discharge, an examination in a clinic within one week after discharge and an updated treatment plan.

The study found that, compared to patients with the same conditions and severity of illness who received normal follow-up care:

• The group given more intensive follow-up care had significantly higher rates of readmission to the hospital and more days of rehospitalization.

• After six months their quality of life was no better than those given normal follow-up care.

• Mortality rates were actually higher in the group of patients given intensive follow-up care.

However, patients given more intensive care did express greater satisfaction with the quality of care they were given.

Physicians suggest that the intervention was ineffective because doctors who saw patients more frequently performed more diagnostic tests and found more conditions to treat. These patients were also more exposed to the risks associated with treatment and hospitalization.

Other studies have found little or no benefit in such preventive measures as detecting and treating early-stage prostate cancer and such follow-up interventions as surveillance to detect recurrence in patients with breast cancer.

Sources: Morris Weinberger et al., "Does Increased Access to Primary Care Reduce Hospital Readmissions?" and H. Gilbert Welch, "Questions About the Value of Early Intervention," New England Journal of Medicine, Vol. 334, No. 22, May 30, 1996.