Between the years 2002 and 2004, a total of 63.5 million American adults annually visited a doctor for a preventive health or gynecological examination. The annual cost is estimated at $8.7 billion, according to an article in Archives of Internal Medicine (JAMA/Archives), September 24th issue.
The researchers/authors explained as background information “The value of many preventive health services is well established, but the role of preventive health examinations (PHEs) (also called periodic health evaluations) for health promotion and screening of disease risk factors and subclinical illness remains controversial.”
The majority of doctors and patients say it is important for patients to have a yearly check up. However, major North American clinical organizations do not recommend yearly check-ups.
Ateev Mehrotra, M.D., M.P.H., of the University of Pittsburgh School of Medicine and RAND Health, Pittsburgh, and team looked at data from a survey of office-based doctors carried out between 2002 and 2004 – the survey was considered as nationally representative. Physicians, who were randomly selected, filled in a one-page form explaining their encounters with each of 30 randomly selected patients during an allocated reporting week.
During the three years that the survey lasted, 181,173 outpatient visits took place – 5,387 were preventative health examinations, while 3,026 were preventative gynecological examinations. An extrapolation would give us a national total of 44.4 million adults, or 20.9% of the population.
Rates varied according to region; people in the Northeast are 60% more likely to have a preventative examination than those in the West, say the writers. Also, those with insurance or Medicare are twice as likely to receive a preventative examination, compared to those without health coverage.
Mammograms, cholesterol screening and smoking cessation counseling were given at 52.9% of preventative health examinations, and 83.5% of preventative gynecological examinations. Of 8 preventative services, only 19.9% of them were provided at these examinations, compared to other types of doctor visits. “For example, mammograms ordered at preventive health examinations and preventive gynecological examinations accounted for 22.9 percent and 44.7 percent of all mammograms, respectively. In contrast, of all visits with weight reduction counseling, only 8.8 percent were preventive health examinations and 1.1 percent were preventive gynecological examinations,” the researchers wrote.
The authors concluded “Preventive health examinations and preventive gynecological examinations 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 preventive health examinations and preventive gynecological examinations.”
2007;167(17):1876-1883
Written by: Christian Nordqvist