Medicare challenged by task of changing focus to prevention

I didn't realize Medicare, the government's health insurance program for the elderly, is behind private insurers in preventive care.

"If you take a big step back and look at Medicare spending, 90%-plus of what we are spending is going for the complications of chronic disease," Medicare Administrator Mark B. McClellan said in an interview. "We can get healthier beneficiaries and a lot lower costs related to complications if we can get more prevention."

(Dr. McClellan is an interesting person situated to make broad changes in healthcare at the national level, has doctorates in both medicine and economics, and served as commissioner of the FDA prior to his current role... plus he was also a Plan II honors major at UT!)

Seems the problem isn't Medicare's ability to provide for preventive care, but getting seniors to comply with it.

In the last two years, the program has expanded what had been a relatively limited set of preventive benefits by adding a "Welcome to Medicare" physical exam for new enrollees, blood tests for cardiac risk factors such as high cholesterol, diabetes screening and training to help diabetics keep their blood sugar under control.

Some services are free, such as a blood glucose test for signs of diabetes. Others, such as the physical, require patients to pay part of the cost.

But some of the results have been disappointing to Medicare officials. For example, about 2% of eligible seniors have taken advantage of the physical, according to preliminary statistics.

The track record also is uneven for established preventive benefits that were added to the program in earlier years.

For example, only 36% of female beneficiaries get Pap tests and pelvic exams to screen for cervical cancer, although Medicare covers most of the costs of such services.

And 54% of male beneficiaries get prostate-specific antigen, or PSA, blood tests — prostate cancer screenings that are free.

Too bad because there are tremendous cost savings for taxpayers in getting people to develop a "preventive care" habit rather than having them develop acute emergencies and treating them for it. "A Medicare analysis using data from 2001 found that the program paid nearly $13 billion that year for potentially preventable hospitalizations for a variety of illnesses, including pneumonia and uncontrolled diabetes. A reduction of as little as 5% in the hospitalization rate would produce more than $500 million in savings, the analysis showed."

What also ought to be mentioned by Dr. McClellan or the LA Times writer of this article, "Medicare Looks to Boost Seniors' Use of Preventive Care," is that preventive care better maintains a person's quality of life.