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Millions of people across the country utilize preventive healthcare services every day. Under Section 2713 of the Affordable Care Act (ACA), private health plans must offer coverage for many recommended preventive services and cannot charge you a copayment or coinsurance, even if you have not met your yearly deductible. Recent court rulings could impact whether health insurance under the ACA continues to provide certain preventive health care services without cost-sharing. Let’s look at some of the scope of services available.
Preventive Healthcare Services for All Adults
A range of screenings exists to help identify ailments early before they get worse. Medical professionals recommend colorectal cancer screening for adults 45 to 75 and cholesterol screening for older adults and those with a higher risk. Health coverage may also feature screenings for depression, diabetes, obesity, and blood pressure. Adults who abuse substances like tobacco and alcohol may receive treatment through cessation interventions and misuse screenings with counseling, respectively. Coverage permits lung cancer and tuberculosis screenings for those at high risk for each disease. Providers additionally suggest abdominal aortic aneurysm one-time screening for male smokers between ages 65 and 75. Coverage offers fall-prevention exercise and therapy for those 65 and over who live in a community setting. Healthcare plans make provisions for STD screenings and immunizations for several illnesses too.
Preventive Healthcare Services for Women
Breast cancer mammography screenings are recommended for women 50 and over every two years. Medical experts also believe health providers may suggest screenings for women 40 to 49 or those women at higher risk for breast cancer. Health professionals advise bone density screenings for all women over age 65 and those 64 or younger that have undergone menopause. They also recommend cervical cancer screenings for women ages 21 to 65. Other commonly suggested evaluations include screening for diabetes and STDs for those at a higher risk. Counseling services are also available for women, such as breast cancer genetic test counseling, breast cancer chemoprevention counseling, and domestic violence counseling with screening. Health plans can also cover yearly well-woman visits. This preventive healthcare service involves a physical exam, identifying your health habits and history, and creating health goals. These visits may also feature education, counseling, immunization shots, or screen tests.
Who Uses Preventive Healthcare Services?
In 2020, researchers found that the number of people using preventive healthcare services remains low. Only 8% of Americans undergo routine preventive screening, and 15 out of the 50 states have above-average preventive care usage. Another group of researchers interviewed healthcare industry experts to understand what may influence people to use this type of care. The experts each had at least ten years of experience working in a healthcare-related field. The scientists discovered multiple rationales for individuals who engage in preventive services. Organizational financial and economic decisions most often impacted acquiring patients, including “where to invest resources, what health benefits to cover or how to bill for clinical services.” The researchers also mention that their interviews suggest many hospitals, doctors, and providers receive pay to treat diseases rather than prevent them. They conclude that health plans “have the potential to increase utilization of preventive services with value-based payment models and contractual requirements that include reporting on preventive health quality measures.” Ideally, with such strategies, more people will begin to take advantage of the preventive healthcare services available to them for their betterment. After conducting their interviews, the researchers concluded that an approach with multiple elements would best help more people begin using preventive services. The scientists recommend implementing strong organizational leadership in healthcare, changes in institutional culture, team-based care, systems of care that accommodate preventive services, and the willingness of patients to pursue and participate in preventive care.
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