Governments all over the world are struggling to control the spiralling costs of healthcare – the UK government is no exception. Its long-term strategy includes a much greater focus on prevention: to keep people as healthy and productive as possible for longer. This paper asks whether a greater focus on prevention is a possible lifeline for the National Health Service (NHS) as is often claimed, but it also examines other benefits to society. After considering various examples of prevention and the metrics used to measure their effectiveness, we use tobacco consumption as a case study to evaluate the costs to the public purse and to wider society. We give further examples, including obesity, but in less depth. We find that whilst there are significant benefits to public expenditure, including the NHS, in both cases, these are dwarfed by wider benefits to society both in terms of tangible economic benefits and improved well-being. We offer several suggestions for improving our understanding of the effectiveness of prevention policies in general and how the Actuarial profession can contribute to this debate.

This article discusses how in March of 2023 a District Court in Texas enjoined the U.S. government from enforcing certain preventive care requirements under the ACA for private health insurers. The current order by the Court enjoined enforcement of the ACA preventive care requirements based on those recommendations made on or after the date of March 23, 2010, by the U.S. Preventive Services Task Force. This article discusses the Court’s analysis and the remedy the Court decided on after finding violations under the RFRA and Appointments Clause. The article also discusses the implications and effects of this decision on whether previously covered services that the ACA didn’t allow cost sharing for will now have cost sharing by private health insurers and how that will affect consumers. The article concludes that despite lack of enforcement, private health insurers should not require cost sharing for previously covered services that the ACA didn’t allow cost sharing for before this most recent decision. Cost sharing for previously covered services would increase costs for those enrolled in private health insurance plans and could lead to a reduction in access to preventive services and healthcare.