Preventative Care Overview


Doctors perform preventative care in an effort to prevent an illness or injury.
Doctors perform preventative care in an effort to prevent an illness or injury.
© Photographer: Starfotograf | Agency: Dreamstime

Preventative care and services are measures that are performed in an effort to prevent an illness or injury. Common examples of preventative care are immunizations and yearly physicals. In fact, any screening test done in order to catch a disease early is considered a preventative service, such as routine Pap tests for women or prostate exams for men. Medications, like low-dose daily aspirin therapy, and counseling services, such as nutrition and exercise guidance, are also examples of preventative care and services.

In this article, we'll find out if these preventative steps actually make any difference in your health.

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According to an August 2007 study by the Partnership for Preventative Care, preventative services are grossly underused, with racial and ethnic minorities receiving the least amount of preventative care in the United States. After studying the top 12 preventative care services, the authors concluded that if Americans began to utilize any five of them, up to 100,000 lives could be saved in just one year.

These lifesaving preventative measures are not expensive or particularly physically taxing. For example, the study estimates that less than half of adults in America use low-dose aspirin therapy. However, if 90 percent of all men over 40 and women over 50 took a daily low-dose aspirin, it could save up to 45,000 lives a year.

Similarly, more than 42,000 lives could be saved annually if doctors offered their smoking patients medications or counseling services in order to help them stop smoking. Today, doctors offer such medications or services to a mere 28 percent of patients after they have advised them to stop smoking. An additional 30,000 lives could be spared with the use of screening tests for breast and colorectal cancers, along with a simple flu shot. Currently, these screening tests and immunizations are underused, with less than 40 percent of all adults getting an annual flu shot.

Some may assume that preventative care is reserved for aging baby boomers. But the next section explains who can benefit from preventative care and exactly which services they should be utilizing.

Most Effective Preventative Services

1. Daily aspirin use for men over 40 and women over 50

2. Childhood immunizations

3. Smoking cessation advice and tools to help you quit

4. Hypertension screening and treatment for adults 18 and older

5. Cholesterol screening and treatment for men 35 and older and women 45 and older

Types of Preventative Care

Children are the most frequent recipients of preventative care and services.
Children are the most frequent recipients of preventative care and services.
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Children are the most frequent recipients of preventative care and services. The majority of these services are in the form of immunizations, which work to prevent children from developing illness such as polio, measles and mumps. The rate of immunizations is rising each year and remains one of the few preventative services with little disparities in rates between racial and ethnic groups. Other preventative services for children include the charting of the child's height and weight, which works as an early screening tool for any developmental problems. Due to the increase incidence of Type II diabetes and obesity in young patients, increasingly common preventative services include nutritional services and exercise information. ­

­Women have a number of preventative screening tests to take advantage of. Adult women (and men) should have their cholesterol levels checked yearly and their blood pressure checked every two years. Once sexually active, or once they've reached the age of 21, every woman should get a Pap test, which is a screening tool for cervical cancer. As long as these test results are normal, the test can be repeated once every one to three years. Women over the age of 40 have different preventative needs. At this age, women should begin to get mammograms every year or so, which screen for breast cancer. Women over 50 should also get a test to screen for colorectal cancer. Women over 65 should have regular bone density testing to screen for osteoporosis.

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Along with screening tests, there are several medications that can help women prevent illnesses like osteoporosis. Calcium is a common preventative medicine that can prevent a number of bone problems. Pregnant patients often take a plethora of preventative medications, including prenatal vitamins, iron and folic acid -- all in an effort to prevent any complications.

The first and most common preventative tests for adult men are regular checks of their weight, cholesterol levels and blood pressure. For men over 50, a test to screen for colorectal cancer is recommended. Men older than 50 should also consider prostate exams to screen for prostate cancer, with current studies suggesting that they should be done every four years. Of course, along with these tests, preventative care includes counseling on different prevention practices including proper diet and exercise, safe sex practices and even smoke detectors in the home.

So now you know which preventative care you, your child, or your mate needs. But what will your insurance plan cover? The next section can help answer that question.

Preventative Services and Insurance Plans

All insurance plans do not cover every kind of preventative care.
All insurance plans do not cover every kind of preventative care.
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Insurance coverage for preventative care and services varies widely among health care plans. Catastrophic insurance (or a High Deductible Health Plan) is a type of fee-for-service policy that is designed to give protection against a health catastrophe. In exchange for the plan's low monthly premiums, usually around $25, you receive a higher deductible than most plans, as well as less health care coverage. Therefore, preventative services like routine physicals or cholesterol screenings are not covered.

Managed-care plans do offer some preventative care. Normally, each plan has a predefined schedule of covered screening tests. These schedules are based on a patient's age, sex and any risk factors. In most managed-care plans, these schedules are based on guidelines published by the U.S. Preventive Task Force and the American Academy of Family Physicians.

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Preventative care in a preferred provider organization (PPO) can vary depending on this predefined screening schedule. When shopping around for health insurance, ask about preventative care coverage. Common preventative services found in PPO plans are routine physical exams, some adult immunizations, routine gynecological exams and Pap tests for women, mammographic screening for any women over 40, pediatric care and immunizations.

Health maintenance organization (HMO) plans were the first to put an emphasis on preventative care, and they offer these services along with the usual health benefits all for a low monthly fee. Since the beginning, HMOs have encouraged wellness and illness prevention with the belief that these preventative measures are more cost-effective than treating chronic conditions that develop due to lack of screening. In addition, HMO plans require that the patient have a primary care physician (PCP). This allows you to have one regular site of care, and studies have shown that this helps ensure proper preventative care on the proper schedule.

Preventative services that are not covered by most insurance plans are also based on the guidelines published by the U.S. Preventive Task Force and the American Academy of Family Physicians. These noncovered services can also vary by plan, but common examples include bladder cancer screening, routine EKGs for asymptomatic patients, screening asymptomatic patients for Hepatitis B or C, and ovarian cancer screening.

To learn more about preventative care and services, check out the links on the next page.

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More Great Links

Sources

  • AHRQ: Women: Stay Healthy at Any Age. http://www.ahrq.gov/ppip/healthywom.htm
  • AHRQ: Men: Stay Healthy at Any Age. http://www.ahrq.gov/ppip/healthymen.htm
  • AHRQ: Guide to Clinical Preventive Services. http://www.ahrq.gov/clinic/cps3dix.htm
  • Partnership for Prevention.http://www.prevent.org/content/view/129/72
  • Preventative Services for Healthy Living. http://familydoctor.org/online/famdocen/home/healthy/prevention/175.html
  • Department of Management Services: Preventive Care. http://dms.myflorida.com/human_resource_support/state_group_insurance/ds­gi_webcenter/active_employee_webcenter/medical_plans_active_employees/preventative_care