By NextBestFitPrevention and public health are underfunded
Public health was $157.6B of $5.28T in 2024 (about 3%). Chronic disease (diabetes, heart disease, obesity) drives most spending.
Evidence
- Government public health activity $157.6B (2024).Sources: CMS Office of the Actuary (2025)
Who's affected
Who is hurt
- People who will need care in the future: Limited prevention funding leaves chronic disease driving treatment needs.
- People with ongoing or specialist care needs: Limited prevention funding leaves chronic disease driving treatment needs.
Who gains while it lasts
- Hospitals, clinics, and care organizations: More chronic disease creates more treatment business.
Under your mix of paths
Paths that fix or soften it
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Root causes
- Payment for treatment, not prevention
- Short budget horizons
Related costs
Open questions
- How much should shift from treatment to prevention and public health?
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Fixed share of health spending for public health, protected from cuts.
- +Prevention and public health are underfunded
- −Leaves funding vulnerable or inflexible
- −Makes performance and quality hard to oversee
No charges for screening, vaccines, and preventive visits.
- +Prevention and public health are underfunded
- −Low-value care and overtreatment
- −Raises spending or loosens control over it
Also addressed by paths for other problems
Capitation for primary care and integrated systemsU.S. prices are far higher than in other countriesChosen
Fixed payments per enrolled person reward prevention rather than additional services.
Invest outside health careWorse outcomes than peer countries despite the highest spendingChosen
Spending on public health addresses root causes of the outcome gap, with benefits extending beyond health.