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January
2004
Prevention Deficit
Disorder
We have been saying forever that government policy makers give
too little support to the evidence linking behavior with better
health. As we enter an election year, they are finally paying some
attention.
The prevention element of the controversial new Medicare legislation
is a welcome recognition that how people and large government programs
behave can improve both individual health and public policy.
The bill was controversial
for so many reasons having to do with politics, payments and
pharmaceuticals. But one lesser known facet
of the new law makes it easier for many of America’s elderly
to act on information about their health, which they would not
have had the opportunity to do until now.
Under the new law, everyone entering the Medicare system will
be screened for cardiovascular disease. All new entrants will get
a free checkup consisting of an electrocardiogram and a height
and weight measurement, along with counseling and referral to specialists
for necessary mammograms, colonoscopies and vaccinations. In addition,
Medicare will offer a chronic disease-management benefit for the
first time.
Most Medicare recipients already received some prevention services,
but in 2000, only one-third of seniors who had high blood pressure
or high cholesterol reported having ever been told of their condition,
according to the General Accounting Office.
So under the more comprehensive Medicare protocol to go into effect
next year, the critical questions are whether physicians will do
a better job of telling their patients what is found in these screenings
and whether people actually will make use of the advice, drugs
and referrals they get. The answer may be in the design and execution
of follow-up programs.
While there is no reason
to believe that the physical exam for new beneficiaries will,
indeed, have long-term health effects,
it may encourage older people who haven’t yet received a
mammogram or flu and pneumonia vaccinations to get them routinely.
Similarly, there is some evidence that knowing the risk for a specific
disease helps some people make changes in their daily habits, and
that’s a start.
The disease-management benefit will begin as a pilot program but
may spread nationwide. It is aimed at Medicare beneficiaries with
chronic conditions and, unless they choose not to participate,
it will provide them with education and support to manage their
illness and reduce the risks of later complications.
Certainly, more could be done: The ongoing Medicare smoking-cessation
demonstration project is receiving enthusiastic reviews and provides
a model for behavioral risk reduction. As the population ages,
more tools are needed for older Americans to enjoy their longer
lives.
Whatever else it does, the new Medicare will establish a health
baseline for new beneficiaries and deal with some preventable and
costly diseases before they get costlier and less preventable.
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