One of the mantras of the massive health care reform law passed last year was: Prevention, prevention, prevention. Through screenings, vaccinations and medications, Americans can be healthier and avoid major medical bills.
That's why the new law declared that some preventive measures should be covered without co-pays or other out-of-pocket expenses to patients.
Last year, the federal government issued rules requiring many health plans to cover services like blood pressure and cholesterol tests, colonoscopies, mammograms, and routine vaccinations without charging co-pays or deductibles.
Some basic preventive care — vaccinations, for instance — makes sense for everyone. Other screens and scans are smart for smaller slices of the population, depending on age, condition, gender and genetic profile. The overarching point: More isn't necessarily better.
Recently the Institute of Medicine issued a set of recommendations for women's health services that should be covered without out-of-pocket charges. Those include contraceptives; screenings for gestational diabetes in pregnant women; DNA testing for the human papillomavirus (HPV) as part of a cervical cancer screening; counseling and equipment to promote breast-feeding, including rental of breast pumps; at least one annual preventive health exam; and annual counseling on sexually transmitted infections for all sexually active women.
The U.S. Department of Health and Human Services (HHS) recently approved those recommendations. Some insurance plans will be required to offer those services beginning in August 2012. Eventually, most plans likely will follow suit.
A consortium of women's health organizations hailed the IOM recommendations as "good for women's health and their pocketbooks." No argument here.
But what about the cost of all that? The IOM report says "cost effectiveness was explicitly excluded as a factor that the committee could use in developing recommendations …"
Too bad. We aren't suggesting that any of those recommendations aren't important or that they won't promote women's health.
But remember this rule of thumb: In general, preventive care doesn't save money. "Hundreds of studies have shown that prevention usually adds to medical spending," wrote Rutgers economist Louise Russell in a 2009 article in the journal Health Affairs. Four out of five preventive options, she says, "add more to medical costs than they save."
For instance: Screening for cervical cancer every two years instead of every three costs more than $1 million for every year of life saved, Russell told us, "because the disease in the huge majority of cases is a slow moving disease, so you don't pick up enough new cases with annual screening to achieve much." The IOM wisely recommends such screening, including the HPV test, no more than once every three years for women 30 and over.
Even if the patient doesn't directly pay, screenings and other health promotions aren't free. Insurers pass on the costs to its customers, driving the cost of health care higher for everyone.
Federal officials need to be careful when choosing which measures the government will order insurers to cover without out-of-pocket fees. Do all the recently recommended measures for women merit no-patient-fee coverage? We'd like to see cost-benefit numbers before making those calls.
Co-pays and cost sharing give people incentives to shop for medical care more carefully. Only those screenings and other health measures that show the greatest benefits for the cost should be covered without out-of-pocket payment.
And remember, effective prevention doesn't have to cost a lot. Stop smoking. Lose weight. Get more exercise. All of those actions improve health and go easy on the wallet.