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Affordable Care Act Expands Women’s Preventive Health Services

There was no large fanfare but there should have been as a result of the Institute of Medicine’s (IOM) recent recommendations that require new health insurance plans to provide preventive services at no cost to the patient. That’s right. No cost. Oh, how women needed this victory in the midst of these trying, turbulent times of economic scarcity. You will no longer have to go to a healthcare provider’s office and turn your pockets inside out or empty your pocketbook on the table before someone will give you a PAP smear or an annual exam. We all know the old adage: “An ounce of prevention is worth a pound of cure.” Well, our healthcare policy makers actually believe this. This policy represents change; change that will make a difference in the quality of your life. And your daughter’s life. And your grandmother’s life. It will help your bank account when you no longer have to write that check for preventive services that could prolong and add to the quality of your life. What brought about this change? The Affordable Care Act. Yes, that same healthcare act that has been politically vilified and called everything except a child of God. That Act.

On August 1, 2011, the Department of Health and Human Services, under the leadership of Secretary Kathleen Sebelius, issued a press release outlining these new, historic benefits that will be implemented on August 1, 2012. “The Affordable Care Act helps stop health problems before they start,” said Sebelius. We all need to stand up and cheer.
What will these new services include at no cost to the patient?

• FDA approved birth control methods
• One annual well-woman exam
• Intimate partner violence screening
• HPV cervical screening and counseling
• Gestational diabetes for pregnant women
• Breast feeding support, including counseling and supplies
• HIV screening
• Sexual infections counseling
• Mammograms
• Colonscopies

The compassion of our healthcare system appears to be returning. It’s been long, long, overdue.
For more information regarding expanded women’s preventive health services, please visit: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html

*This blog post was originally published at Dr. Linda Burke-Galloway*


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7 Responses to “Affordable Care Act Expands Women’s Preventive Health Services”

  1. Ellana says:

    It does cost someone to provide these”free to the patient” services. If it is an employee health plan, all employees foot the bill in higher premiums or reduced coverage for other care when they are sick and by lower salaries overall. If a government supported plan the 50% of us paying taxes pay for this. Being female and sexually active is not a medical condition.

    Where is the coverage for men-free condoms, HPV vaccines, breast cancer screening etc.

  2. Ben says:

    I tend to agree with Ellana here… “Free” in this context means “You won’t have to pay for this service because I will have already taken the money from you via premiums” (I don’t know if you’ve looked at the rate of increase in premiums over the last 18 months, but they are appalling).

    Also, I have to wonder whether all the optimism around preventative care is founded in any real science… particularly on the cost-side of the equation. We keep hearing that we’ll save money in the long run if we invest in preventative care, but to my knowledge this is more of a hunch than an economic reality. Insurance groups have mind-numbing amounts of data on the cost-benefit ratio of preventative care, and -to gauge from their policies – they seem to have been rather unimpressed by their findings.

  3. cmhmd says:

    >>Insurance groups have mind-numbing amounts of data on the cost-benefit ratio of preventative care, and -to gauge from their policies – they seem to have been rather unimpressed by their findings.<<

    Don't confuse screening with preventive care. Screening often finds thing that are very expensive to evaluate with no benefit to the patient. Preventive care is preventing bad things from happening to people, whether that be preventing unwanted pregnancies, avoiding diabetic complications or simply preventing flu or HPV with vaccines.

    Regarding the insurance companies data and decisions, they are in the position of being able to kick the can down the road. We all change plans so often it is unlikely that the company deciding you don't need a certain type of care will not have to deal with the consequences of not getting it. So, their decisions are not beneficent, they are to avoid costs, period. Medicare and the VA, like other countries' systems, recognize that all the costs and benefits accrue to them and their patients throughout their lives, thus improving quality is the prime goal.

  4. Brian says:

    Ben-I am surprised that you are unconvinced (or wondering as you put it) about the savings inherent to the preventive services mentioed in the article. I’m curious of your sources…can you steer me please? I would encourage you to look at the current data on the Institute of Mediine’s website. The latest update on the evaluation of essential benefits, which was commissioned by HHS, lists value as a key component of the analysis. So, actually and thankfully, the recommendations have already been vetted by about 15 stakeholders here, including insurance companies reps and heath policy experts. The ACA dedicates more resources to ensurig value than ever before.

    Great point cmhmd…key benefit of the ACA is to base policy decisions, including preventive benefits, on maximizing comprehensive value to the country, not the perverse incentives leading insurance companies towards short-sightedness and waste.

  5. Brian says:

    Check out “The Healthcare Initiative, 2010″ data on savings through prevention benefits. The LOWEST BOUND on a number of cost estimates for “Missed Prevention Opportunities” was $55B, which was adjusted down to 2009 expenditures. Very conservative estimate; much more helpful than putting out false information based on “having a hunch” and wondering if it’s based in science. These tactics cost us money and cause harm to patients needlessly.

  6. Ben says:

    I think that cmhmd made a good point insofar as insurances’ incentives (though insurances are often stuck with patients for decades) but I’m not sure looking to universal systems elsewhere is a good counterpoint… in fact, it helps underscore my point: I’m not necessarily against centralized healthcare (it often seems better than the mess we have now), but these government-run systems have been no better at holding down costs than we have: The healthcare inflation rate for the UK and Canada has been on par or higher than ours for some time, and their lower per-capita costs are based almost exclusively on starting from a lower baseline (which they achieved largely by cutting pay for medical professionals when they were set up). Even when you look specifically at the sectors where preventative care is supposed to save us lots of money: obesity-related disease, smoking, STDs, etc, the systems with more preventative care are doing no better than we are:

    Canada and the UK are getting fatter even faster than the US (though Canada is starting from a lower baseline)
    In the UK – like in the US – smoking rates which were falling rapidly for 35 years have leveled-off since ~2005 (Canada’s drop has continued, but they attribute that to the fact that significantly stricter controls on sales and advertising)
    On the STD-front, the UK and Canda have both seen a significant increase in overall STD rates and specifically unsafe-sex practices since 2001. Their rates-increases are virtually identical to ours.

    Most preventative care scenarios rely on the assumption that doctors can have a significant impact on the lifestyles of people who are not currently suffering health problems. I have not seen any good evidence that this is generally very effective.

    The New England Journal of Medicine had a look at the question of “does preventative care save money” and came to the conclusion of “no, maybe, sort-of”. They said that there were some interventions (many vaccines, for instance) were cost-saving, but that because some preventative care is ineffective, and because many treatments are cheap (my Lisinopril costs a few cents a day), we need to be very careful about what we choose to cover. The director of the CBO came out to directly to say that existing preventative care guidelines were going to increase overall cost: “After reviewing hundreds of previous studies of preventive care [...] slightly fewer than 20 percent of the services that were examined save money, while the rest add to costs”. He went on to say “another recent study conducted by researchers from the American Diabetes Association, the American Heart Association, and the American Cancer Society estimated the effects of achieving widespread use of several highly recommended preventive measures aimed at cardiovascular disease—such as monitoring blood pressure levels for diabetics and cholesterol levels for individuals at high risk of heart disease and using medications to reduce those levels.4 The researchers found that those steps would substantially reduce the projected number of heart attacks and strokes that occurred but would also increase total spending on medical care because the ultimate savings would offset only about 10 percent of the costs of the preventive services, on average. Of particular note, that study sought to capture both the costs and benefits of providing preventive care over a 30-year period.”

    The basic point here is that just because a specific instance of prevention is cheaper than treatment doesn’t mean that we can prevent more cheaply than we can treat. In my experience, it’s policy makers (who want win-win solutions) and the classes of doctors who would be providing preventative services who are doing the most to push this agenda. I just think we should reserve our optimism, and incorporate preventative measures only insofar as they can demonstrate efficacy.

    Also, @cmhmd, on both sides of the debate, screenings seem to be in everyone’s definition of preventative care… I think it may be worth parsing out, but in the current discussion they are included, as they were in the original article

  7. Ben says:

    Also, @Brian, I’m presuming that you’re looking at the NCBI report (in the section “Missed Prevention Opportunities”)… I think you’re looking at only the “Total Savings” number (~$55B), but not at the “Net Health Expenditures” number, which they also generate. This is only to “benefits” side of the calculation and does not include the costs of delivering those services. If you look at the full data-spread, there is also a “Total Delivery Costs” column which they put next to the Total Savings column, which eats up almost the entirety of the benefit. The “Net Health Expenditures” column shows a savings of only $1.7B/yr… and this calculation was done with only a small sub-set of low-cost preventative measures. In other words, even in a best-case scenario (where we’re only applying the preventative measures that NCIB found to be net reducers of cost) the total benefit is still a trivial 0.4% of “Marginal Net Health Expenditures”.

    Certainly we should go for these very few low hanging fruit (which were basically: give patients the flu vaccine and tell them to quit smoking), but let’s not oversell preventative medicine as a whole.

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