Walter Jessen of Highlight Health has done a fantastic job of hosting this week’s Grand Rounds, with a theme revolving around the impacts of healthcare reform. I found this article by Dr. Lucy Hornstein to be particularly interesting. Dr. Hornstein takes the view that preventive care does not save money in the long run, and wonders if the provision in the PPACA to provide preventive care to everyone – with no copays or deductibles – is a wise idea. The discussion is made even more interesting with a comment from Maggie Mahar (who was referenced in the article) noting that some preventive care is more worthwhile than others.
In recent years, we’ve seen controversy about how effective some of our routine preventive care actually is – mammograms, PSA testing, annual paps… there’s evidence that less frequent use of these tests is the way to go. However, my guess is that doctors who get paid for doing the tests, and the medical supply companies who make the testing equipment and supplies, preferred the older guidelines that called for more of these procedures.
Although I strongly agree with Maggie that there are definitely some benefits to seeing a doctor on a regular basis – especially if appointment time is devoted to talking rather than testing – I do have concerns about the PPACA provision that health insurance policies provide preventive care with no cost-sharing on the patient’s part, simply because making healthcare “free” tends to create a disconnect in patients’ minds about the value and actual cost of the care provided. The preventive care system under the PPACA is definitely not set up to provide unlimited preventive care at no cost to the patient. Only specifically recommended care will be reimbursed at 100%, and it’s likely that the guidelines around the recommended screenings will change as time goes on. But even with the best guidelines, screening does not equal prevention.
It’s interesting that we refer to screening tests as “preventive care” – after all, those tests are designed to find problems after they have begun (although it’s true that some tests, like the pap, can find abnormalities before they actually manifest into disease), rather than prevent the problem in the first place. Wouldn’t it make more sense to focus our attention on strategies to actually prevent diseases, rather than just find them soon after they develop? Of course, that would require some major changes in how our food supply works, and in the opportunities we provide for people to be healthy. It’s easier to just offer up testing instead.
A friend of mine who is in excellent health recently went to her doctor for a physical. She mentioned that her health insurance (a travel policy) covered preventive care (although she didn’t know how much was covered – turns out that the policy covered up to $250) and before she knew it, the doctor had done a thousand dollars worth of testing on her. There’s part of me that wonders how much of that testing was actually beneficial to my friend, and how much was beneficial to the doctor. I know that it feels good to tell people that preventive care is covered on their policy, and that they can go to the doctor for a checkup without paying anything. But I’m not 100% convinced that having such coverage will actually improve our health over the long-run, and there is still quite a bit of debate about whether it’s a good idea from a financial standpoint.