GAO Assessment of Preventive Care

The reform law required all health benefit plans to cover preventive care without cost-sharing, with preventive care being that recommended by the U.S. Preventive Services Task Force.  The theory is that removing disincentives to receive these services will lead to lower health spending in the long run.  There continues to be debate about the value of all these preventive services, and where they are truly either cost-effective, meaning that even though the service adds cost, it is worth it in terms of outcomes or is a less costly way of achieving the same outcome, or cost-saving, meaning the service has been shown to reduce overall spending over some period of time.  The General Accounting Office took a look at what the literature says about what preventive services have demonstrated that they are worth insisting on being available for free.   (GAO Report)   GAO found only 29 articles addressing the topic, although some covered more than one service, indicating the paucity of credible research on this important topic.

Here are some of the services found to be cost-effective and which of those were cost saving.  Designated as both cost-effective and cost saving were comprehensive foot care for diabetics to prevent ulcers, multicomponent interventions for patients with Type 1 and Type 2 diabetes to maintain good glycemic control and avoid complications; using aspirin to avoid heart attacks; drug treatments to prevent end-stage renal disease; smoking cessation counseling and drug treatment; one-time colonoscopy screening  bone mineral density screening with drug treatment; screening hospital patients for MRSA; influenza and rotavirus vaccinations for children and influenza vaccination for the elderly.  More preventive services were cost-effective but not cost-saving, for example, implantable defibrillators; balloon  and stent treatment of lower leg vascular vessels; intensive insulin treatment; using aspirin to prevent stroke; hormone therapy to prevent breast cancer; some types of smoking cessation counseling; and mammography for women aged 40 to 49.    It seems a fair conclusion to draw that many of the “free” preventive services aren’t supported by research evidence on their value and that politics and pressure from advocacy groups may have as much to do with some services being deemed preventive under the reform law.  And there is a cost to all this free prevention, many of the screenings can be quite costly.