Preventive Health Care

What's the Problem?

Nationally, Americans use preventive services at about half the recommended rate. Cost-sharing such as deductibles, co-insurance, or copayments also reduce the likelihood that preventive services will be used. One study found that the rate of women getting a mammogram went up as much as 9% when cost-sharing was removed.

Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among Americans each year and account for 75% of the nation’s health spending. These chronic diseases can be largely preventable through close partnership with your healthcare team, or can be detected through appropriate screenings, when treatment works best.

Eating healthy, exercising regularly, avoiding tobacco, and receiving preventive services such as cancer screenings, preventive visits and vaccinations are just a few examples of ways people can stay healthy. The right preventive care at every stage of life helps all Americans stay healthy, avoid or delay the onset of disease, keep diseases they already have from becoming worse or debilitating, lead productive lives, and reduce costs.

And yet, despite the benefits of many preventive health services, too many Americans go without needed preventive care, often because of financial barriers. Even families with insurance may be deterred by copayments and deductibles from getting cancer screenings, immunizations for their children and themselves, and well-baby check-ups that they need to keep their families healthy.

The Affordable Care Act (ACA) makes preventive care affordable and accessible by requiring certain private health plans to cover certain recommended preventive services without charging a deductible, copayment, co-insurance, or other cost sharing. Under this new requirement, those services including well-woman visits, support for breastfeeding equipment, domestic violence screening and counseling, became more broadly available without cost sharing. More information on the requirement that insurers cover cost-free preventive care is available at: Shining a Light on Health Insurance Rate Increases

For people with Medicare, The Medicare Improvement for Patients and Providers Act (MIPPA) of 2008 established a three-part standard for Medicare coverage of preventive services, and the ACA directs Medicare to waive beneficiary co-insurance and deductible liability for certain covered preventive services.

Who's at Risk?

Opportunities for prevention impact all Americans, regardless of age, income, or perceived health status. Each year, potentially preventable chronic diseases (e.g., heart disease, cancer, diabetes) are responsible for millions of premature deaths among Americans. The five leading causes of death in the U.S. are heart disease, cancer, chronic lower respiratory disease, stroke, and unintentional injuries. Because health problems impact productivity, health problems are a major drain on the economy, resulting in 69 million workers reporting missed days due to illness each year. This loss of productivity reduces economic output by $260 billion per year.

Although most Americans underuse preventive services, individuals experiencing social, economic, or environmental disadvantages are even less likely to use these services. Examples of obstacles include lack of access to quality and affordable health care, lack of access to healthy food choices, unsafe environments, and a lack of educational and employment opportunities.

Can It Be Prevented?

Preventing disease is key to improving America’s health and keeping rising health costs under control. When we invest in prevention, the benefits are broadly shared. Children grow up in communities, homes, and families that nurture their healthy development, and adults are productive and healthy, both inside and outside the workplace. Businesses benefit because a healthier workforce reduces long term health care costs and increases stability and productivity. Furthermore, communities that offer a healthy, productive, stable workforce can be more attractive places for families to live and for businesses to locate. Further discussion of these benefits is available in the National Prevention Strategy at: Prevention & Getting Care.

The ACA has already helped women in private plans with cost-sharing, like waiving coinsurance or deductibles for certain preventive services such as mammograms, cholesterol screenings, and flu shots, amongst other benefits.

The Bottom Line for Consumers

• Eliminating cost-sharing (e.g., deductibles, co-insurance, or copayments) for certain preventive services increases the likelihood that preventive services will be used. The government is making strides to broaden private health plan access to recommended preventive services with no cost or low cost-sharing.
• You may have no insurance copays or other out-of-pocket costs for certain visits and preventive screenings to detect disease in the early stages, when it is most treatable.
• Preventing disease before it starts is critical to helping people live longer, healthier lives and keeping health care costs down. Preventive services can also help those with early stages of disease keep from getting sicker.
• Counseling on such topics as quitting smoking, losing weight, eating better, treating depression, and reducing alcohol use can improve health and reduce costs by preventing illness.
• Receiving routine vaccinations in accordance with your doctor’s recommendations can help prevent diseases such as measles, chicken pox, or meningitis, as well as flu and certain kinds of pneumonia.
• Counseling, screening, wellness visits, prenatal care, etc., can improve health and reduce costs by preventing illness.
• Health problems are a major drain on the economy, resulting in 69 million workers reporting missed days due to illness each year, and reducing economic output by $260 billion per year. Increasing the use of proven preventive services can encourage greater workplace productivity.

Case Examples

1. Joe Smith always considered himself to be a healthy individual. As far as he was concerned, he ate the right foods and exercised enough. As a result of the ACA, Joe learned that his health care insurance plan was now offering free diabetes screenings. Since he could get a screening during lunch, Joe decided that it couldn’t hurt to take part. To Joe’s surprise, the results of his weight and blood tests showed that he was pre-diabetic with a blood sugar level of 101. As a result of the test, Joe met with his health care provider and learned about the types of foods he should be eating, as well as suggestions for improving his exercise regimen. After five months of the new diet and exercise program, Joe was able to lose 24 pounds and reduce his blood sugar so that he is no longer considered pre-diabetic.
2. Judy Davis, an independent consultant was living a fast-paced life. As a single mother with two small children, she focused all of her energy on her work and family. Although her kids ate well-balanced meals, she relied on coffee and cigarettes. Her only exercise was running after her kids. As a result of the ACA, Judy learned that she was eligible for free preventive services with her private health care plan. This included screenings for breast cancer. After a Mammogram, her doctor told her that there was a sizable lump in her breast and recommended a biopsy. Results confirmed that Judy had breast cancer. After a lumpectomy and many months of radiation, Judy decided to change her lifestyle to make sure she would be around to watch her children grow up. Judy quit smoking, began eating healthy, and started exercising. As a result of catching her cancer early, when it was more easily treatable, Judy has a new lease on life and is now cancer-free.