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Health insurance and health screening

There’s an important new piece of research from Ireland where they have a mixed public/private health service. It focuses on the use of screening services for breast, cervical, colorectal and prostate cancers, and identifies a major difference in the uptake of these service across the income range. Those in the higher income groups are more than 10% more likely to use the services than those in the poorer groups. As a result, more people from the lower income groups die from the various cancers because treatments are delayed until the growths of significantly advanced. The research shows people who carry private insurance use this buying power to jump the queue and gain access to services more or less on demand. Those on lower incomes find themselves in long queues waiting for appointments and are often deterred from going through the screening tests. As an aside, the study also notes the take-up is higher among married people. The assumption is spouses nag until the tests are performed. Without similar pressure, singles are less likely to take the trouble.

The Affordable Care Act is supposed to positively encourage preventive medicine — it’s one of the ten areas of medical care to be covered by the mandate. Yet, the insurance industry is still waiting for the Department of Health and Human Services to issue regulations defining which benefits are “essential”. This is a cultural problem. We’ve never been a country that believes in preventive medicine. We always wait until we’re ill before seeking help. As from 2012, insurers are required to cover annual physicals, vaccinations and a surprisingly large number of screening tests. HHS has begun to list services that must be included in the mandated plans but, as Rick Perry discovered in the Presidential Debates, not everything uncontroversial. Some states have already introduced rules for papillomavirus vaccinations in young women to prevent cervical cancer. Yet the Tea Party activists attack this as encouraging promiscuity among their children. So it’s not just a case for the HSS to define preventive measures on medical grounds. There are a lot of political problems to overcome as well. This is leaving gaps and ambiguities in the regulations being issued by HHS.

If we are to develop a service that delivers real improvements to our national health, we must learn from the Irish research. It’s not enough to make federal money available to put screening services in place. There must be equality of education and access. There must be a major outreach to the poorer communities to positively tell them what’s available and how it will help them. Then there must be fairness and equity in the appointment systems. No one must be allowed to jump the queue simply because they have more money available under their group or individual health insurance plan or because they are considered “higher status”. There should be as much equality as possible in the provision of healthcare services. So, for now, we wait on the HHS to produce a full list. For example, we now know health insurance plans must pay for colorectal cancer screening once every ten years once you are over the age of 50. Let’s hope the HHS can navigate this dismal swamp of conflicting interests to come up with preventive medicine that really does save lives regardless of income.


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