Income and Use of Preventive Services

The reform law mandates that health services deemed preventive be made available without cost-sharing.  The theory is that receiving preventive care leads to lower health spending in the long run.  This theory is not yet supported by the research.  Removing cost sharing drives up premium costs, likely leading to increased premium share for covered persons.  Bureaucrats and social engineers never seem to tire of this idiotic whack-a-mole game where trying to knock something down in one bucket just pops it up in another one.  But it is also not clear that removing cost barriers to certain kinds of care is enough to ensure that people get these supposedly necessary services, as is demonstrated by a recent Centers for Disease Control brief looking at the relationship between income, insurance status and receipt of preventive care.   (CDC Brief)   The study used self-reported survey data, so reader beware, on six preventive services–shingles vaccination, influenza vaccination, pneumonia vaccination, tetanus vaccination, smoking cessation discussion and HIV testing.  We can’t resist suggesting that this list reflects the questionable nature of many supposedly direly-needed preventive services.  In any event, overall rates of receipt of these now-free services was surprisingly low, even considering that the service doesn’t make sense for many patients.  For HIV testing, it was 42%, smoking cessation, 52%, flu vaccine, 39%, tetanus vaccine, 62%, shingles vaccine, 18% and pneumonia vaccine, 61%.  People with health insurance received five of the services at a higher rate, but still many insureds did not get the service.  Adults with incomes at 200% or more of the federal poverty level also had higher rates of preventive service uptake for five of these services.  And those covered by private health insurance had higher rates that people covered by public programs like Medicaid.  As the report notes, there are obviously other reasons why people aren’t getting these services, such as lack of a regular physician.  The report ignores the most likely reason, however, which is that many of these people don’t think they really need the service or they have a general disregard for their health.   Removing cost barriers doesn’t address those issues.