Dr Weinstock has insightfully identified a maddeningly frustrating problem. Many reimbursement programs do not cover preventive services—services that would improve the quality of life, health, and well-being of our patients. A recent article in The New England Journal of Medicine reported that Medicare patients with private insurance were "three times as likely, and those with Medicaid, twice as likely to have a mammogram than... Medicare beneficiaries who must pay out-of-their-pocket a portion of the mammogram cost."1More and more, however, the situation is changing. As managed care, particularly capitated systems, recognizes that the individuals constituting their panel are going to be there for the long haul, it increasingly makes more sense, economic and otherwise, to provide preventive services now than to hope subsequent problems will have an impact on someone else's "bottom line."
Sommer A. Disease Prevention and Health Promotion-Reply. Arch Ophthalmol. 1995;113(11):1356. doi:10.1001/archopht.1995.01100110015006