Preventive services urged as vital element of health plans

Health Care Financing Review, Spring, 1993

All future health care plans--public and private--should include in their basic benefit packages coverage for clinically effective preventive services, according to the American Society of Internal Medicine (ASIM). In recent testimony before the House Ways and Means Committee's Subcommittee on Health, ASIM Executive Vice President Alan R. Nelson, M.D., set out a series of guiding principles for coverage of preventive services under health care reform.

Citing a joint policy statement recently developed by ASIM, the American College of Preventive Medicine, and the American College of Physicians, Dr. Nelson said covered preventive services should generally fall into three categories: screening, including physical examinations and laboratory tests; counseling, to help patients adopt and maintain healthy behavior; and immunization, to prevent infectious disease.

Additional coverage should be included for preventive services for persons assessed to be at risk for particular conditions, Dr. Nelson said; for example, someone with a personal or family history of disease. Coverage of all preventive services should be mandatory, he said, as long as the services have been proven by scientific criteria to be clinically effective and are tailored to and provided with a frequency determined by age and sex.

Dr. Nelson also called for reforms that would make preventive services more widely available to Medicare beneficiaries. Medicare currently excludes from coverage many preventive services such as colorectal cancer screening and immunizations. Dr. Nelson urged subcommittee members to expand Medicare coverage to include clinically effective preventive and screening services. "Effective preventive services improve the quality of life and prolong life. Prevention should be a fundamental component of health care reform," he said.

If managed competition is to be the vessel of health care reform, then "accountable health plans" (or AHPs) should lower the high deductibles that effectively eliminate coverage of primary care and preventive services under many current insurance plans, Dr. Nelson said. He noted that patients rarely see a primary care physician often enough to meet the deductibles of most plans. ASIM believes that as a condition of being certified as an AHP, all plans should be required to establish a lower deductible for periodic health evaluations and other preventive and primary care services.

For more information, contact Alex Gramling at (202) 466-0281.