Many Americans Do Not Get Recommended Preventive Services

Laurie Barclay, MD

July 17, 2015

Many Americans did not receive some recommended preventive health services in 2011 to 2012, according to a report published in the July 17 issue of the Morbidity and Mortality Weekly Report. The report suggests the Affordable Care Act (ACA) may improve uptake of these services.

"Rates of receipt of some clinical preventive services by adults are higher for persons with insurance coverage or higher incomes," write Jared B. Fox, PhD, and Frederic E. Shaw, MD, JD, from the Office of Health System Collaboration and Center for Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia. "The [ACA]'s expansions of health insurance access and coverage requirements for clinical preventive services were developed to increase access to health services to improve the health of the population."

Preventive care can save lives and improve health by early detection of disease and appropriate intervention. The authors note that persons with health insurance are up to three times as likely to receive needed preventive care as uninsured persons. However, even many insured persons did not get receive recommended preventive services in 2011 to 2012, according to combined adult responses to the National Health Interview Survey in those years.

For the nine preventive services studied, all of which are reimbursable according to the ACA, prevalence of receipt of service in the surveyed timeframe was as follows: hepatitis A vaccination, 12.7%; colon cancer screening, 23.6%; dietary counseling, 26.9%; hepatitis B vaccination, 38.8%; diabetes screening, 45.3%; cervical cancer screening, 59.4%; breast cancer screening, 61.6%; cholesterol screening, 70.0%; and blood pressure screening, 82.9%.

For each of the nine services, persons with health insurance were more likely than uninsured persons to have received these services in 2011 and 2012. The highest service receipt prevalence ratio for those with insurance vs for those without insurance was for colon cancer screening (3.13), and the lowest was for hepatitis B vaccination (1.39).

For eight of the nine services, people with higher income were more likely than people with lower income to have received these preventive services. Compared with persons with only public insurance, those with private health insurance received preventive services at a statistically significant higher prevalence for two of nine services, and at a lower prevalence for four of nine services.

"All new private health plans, alternative benefit plans for the newly Medicaid eligible, and Medicare now provide coverage with no copayments or deductibles for many recommended clinical preventive services as part of the ACA," the report authors write. "These provisions might have the greatest impact for higher-cost services like certain colorectal cancer screening methods.... While insurance coverage is not the only barrier to receiving services, efforts to increase enrollment and coverage retention could help increase receipt of preventive services and reduce avoidable complications from illness, long-term health care costs, and premature deaths."

The authors note several study limitations, including reliance on self-report with potential for recall bias, a cross-sectional design precluding determination of causality, and a lack of generalizability to all populations.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015; 64:738-742. Full text

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