Medicare Wants Seniors to Pay Attention to Prevention

Times Staff Writer

With most of Medicare’s $336-billion budget devoted to treating the debilitating consequences of chronic illnesses, officials say they want to close a “prevention gap” created by seniors’ low use of preventive services.

Medicare has lagged behind employer-financed health plans in recognizing the value of preventing illnesses. But the government program that provides healthcare for 43 million elderly and disabled people is planning to launch a campaign this summer to inform beneficiaries how they can make better use of recently expanded preventive services.

“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.”


The campaign will feature a special effort to reach minorities ages 65 and older -- a group that is among the least likely to get preventive care and suffers higher rates of some chronic illnesses. In addition, the 2007 Medicare handbook will focus on preventive care.

And effective immediately, beneficiaries can find out which regular checkups they may have missed by calling (800) MEDICARE -- (800) 633-4227 -- or by visiting

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.

The reasons why more seniors don’t get preventive care are complicated, said Vicki Gottlich, an attorney with the Center for Medicare Advocacy in Washington. They include wanting to avoid costs, lacking transportation to a doctor, not having up-to-date information and being pessimistic about their health.

Inadequate preventive care has been one of the program’s most persistent weaknesses, she added.

“The expansion in preventive benefits has really come in the last five to 10 years,” Gottlich said. “If you combine preventive care with the drug coverage people now have, there could be greater savings to Medicare. In the past, people could get preventive care, but they couldn’t afford the drugs.”

Establishing a standard cost-sharing policy for preventive care would greatly encourage more seniors to take advantage of their benefits, said Dr. Joshua Sharfstein, Baltimore’s public health commissioner. Services that are scientifically determined to be effective should be free of charge, he recommended.

“A promotional campaign is a very good idea, but Medicare should also be erasing any barriers that exist,” Sharfstein said. “Cost should not be a barrier to evidence-based preventive healthcare. If something is cost-effective and it saves lives, it should be provided.”

Getting rid of patient cost-sharing for some preventive benefits would require Congress to change laws, and Medicare officials say they can’t afford to wait for that.

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.

Research has shown that minorities are more likely to be hospitalized for preventable conditions and are less likely to get preventive care such as flu shots.

“There are clear disparities among racial and ethnic groups,” McClellan said. “It’s not surprising that racial and ethnic minorities have the highest mortality rates for many of these conditions.”

Medicare’s prevention campaign will work closely with the National Assn. for the Advancement of Colored People and with organizations representing Latinos, Asian Americans and Native Americans, he said. And McClellan wants to enlist national and local organizations that have helped enroll beneficiaries in the new Medicare prescription plan.

“This grass-roots approach to Medicare is here to stay,” McClellan said. “The only way we are going to close this prevention gap is by taking a personalized approach.”

But the program has a long way to go. Even preventive benefits that are considered a success within Medicare fall short of medical recommendations. For example, 68% of beneficiaries get an annual flu shot, which is highly recommended for all people 50 and older.

“There are thousands of deaths in the Medicare population that could be prevented by better flu vaccination,” Sharfstein said. “The vast majority should be getting the flu vaccine every year. Those vaccines save lives.”



Prevention gap

Medicare is planning a campaign to get seniors to use more preventive care. Some covered services, and the percentage of eligible beneficiaries using them:

*--* Service Medical condition Utilization Pap test and Cervical and pelvic exam vaginal cancer 36% PSA blood test Prostate cancer 54% Mammography Breast cancer 55% Pneumococcal Pneumonia vaccine 65% Flu vaccine Annual flu 68% Cholesterol test Heart disease 83%


Souce: Medicare