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Preventive Health Examinations and Preventive Gynecological Examinations in the United States
Ateev Mehrotra, MD, MPH;
Alan M. Zaslavsky, PhD;
John Z. Ayanian, MD, MPP
Arch Intern Med. 2007;167(17):1876-1883.
Background Preventive health examinations (PHEs) are controversial, and limited data are available on their use and content.
Methods We conducted a retrospective analysis of 8413 ambulatory visits from January 1, 2002, to December 31, 2004, for PHEs and preventive gynecological examinations (PGEs) by adults in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Population estimates were obtained from the Current Population Survey. We estimated rates of PHEs and PGEs by patients' demographic characteristics, the frequency of 8 preventive services provided at these visits, and total costs of PHEs and PGEs at Medicare reimbursement rates.
Results An estimated 44.4 million adults per year (20.9%; 95% confidence interval [CI], 18.2%-23.6%) received a PHE, and 19.4 million women per year (17.7% of adult women; 95% CI, 14.9%-20.4%) received a PGE, together accounting for 8.0% of all ambulatory visits. The PHE rates varied by region (Northeast vs West: relative risk, 1.58; 95% CI, 1.17-2.14) and insurance type (those without vs those with private insurance or Medicare: relative risk, 0.51; 95% CI, 0.40-0.65). Preventive services occurred at 52.9% (95% CI, 48.8%-57.0%) of PHEs and 83.5% (95% CI, 80.7%-86.3%) of PGEs, but only 19.9% (95% CI, 18.4%-21.5%) of 8 preventive services occurred at a PHE or PGE. The annual costs of these visits were approximately $7.8 billion.
Conclusions PHEs and PGEs are among the most common reasons adults see a physician. These visits frequently include preventive services, but most preventive services are provided at other visits. These findings provide a foundation for continuing national deliberations about the use and content of PHEs and PGEs.
Author Affiliations: Division of General Internal Medicine, University of Pittsburgh, School of Medicine, and RAND Health, Pittsburgh, Pennsylvania (Dr Mehrotra); and Department of Health Care Policy, Harvard Medical School (Drs Zaslavsky and Ayanian), Department of Health Policy and Management, Harvard School of Public Health (Dr Ayanian), and Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School (Dr Ayanian), Boston, Massachusetts.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Preventive Services Use Among Women Seen by Gynecologists, General Medical Physicians, or Both
Lewis et al.
Obstet Gynecol 2008;111:945-952.
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