The new healthcare law promises people on Medicare annual wellness exams, mammograms, prostate cancer screenings, and other preventive services—without any co-payment or deductible. The rest of the population will also have access to a lengthy list of preventive services. Unfortunately, the law that mandated these benefits contained no provision to make sure doctors will be able to deliver the services.
What Services Will I Be Entitled To?
All new health plans (plans that are not grandfathered) must now cover the preventive services recommended by the US Preventive Services Task Force, without cost-sharing. Depending on your age and sex, the following preventive services must be covered by your health insurance.
- Blood pressure, diabetes, and cholesterol screening
- Cancer screenings
- Counseling on weight loss, healthy eating, smoking cessation, alcohol use, and depression.
- Vaccines for measles, polio, meningitis, and the human papillomavirus (HPV).
- Shots for flu and pneumonia prevention.
- Screening, vaccines, and counseling for healthy pregnancies.
- Well-baby and well-child visits up to the age of 21, as well as vision and hearing, developmental assessments, and body mass index (BMI) screenings for obesity.
- Mammograms for women over age 40.
- Pap smears for cervical cancer prevention.
- Colon cancer screening tests for adults over age 50.
Will I Be Able to Get the Preventive Services Promised Me?
The answer is probably not. Providing preventive care takes time, and most primary care physicians already have their hands full. Nationwide, more than one out of every five people is living in an underdoctored area, and the shortage of primary care physicians is expected to grow worse in future years. Furthermore, since preventive screenings are often reimbursed at lower rates than other services, when you call your doctor for a preventive care appointment, you may find there is a long wait.
Is Preventive Medicine Cost-Effective?
Much rhetoric suggests that preventive care pays for itself. If a disease is caught in its early stages, so it is said, treatment costs will be lower. So can wider access to preventive care lower the nation’s healthcare costs? In general, no.
For an individual with a health problem, the old adage that an ounce of prevention is worth a pound of cure is true. For the few patients who are diagnosed with a disease, preventive screenings are definitely worth the cost. But the cost of screening thousands of healthy patients to find one patient with a problem usually swamps any savings on patients whose diseases are diagnosed early.
In general, preventive medicine adds to healthcare costs, rather than reducing costs. Mammograms don’t pay for themselves. Nor do Pap smears, prostate cancer tests, or general checkups for healthy people. That doesn’t mean we should avoid these tests, but we should obtain them judiciously.
There are some exceptions—childhood immunizations and prenatal care for at-risk mothers, for example. But the exceptions are few and far between. Louise Russell, who has studied the economics of preventive care for many years, explained this in an article in Health Affairs: