Pay Attention to Prevention: A Message That People Don’t Hear

Medicare spends billions of dollars fixing people up after they get very ill and go to the hospital. But lots of money could be saved, and, much more important, pain and suffering would be averted, if people used the vital preventive measures offered by the gigantic federal health system.

The numbers are discouraging, even shocking. Medicare estimates that barely 10% of the people enrolled are using each one of the full list of preventive benefits available to them.

There are free flu shots and pneumonia vaccinations, low-cost screenings for diabetes and cancer, and a “welcome to Medicare” physical, according to Jeff Flick, the CMS administrator for region 9, which includes California.

Here is the preventive care national scorecard available from Medicare, showing a big gap between optimum usage and reality:

  • Pap smear in the past year: 33.4%;
  • Bone mass measurement for women (ever): 34.7%;
  • Blood sugar testing in the past year for people who don’t have diabetes: 48.3%;
  • Digital prostate exam in past year: 49.1%;
  • Fecal occult blood test (ever): 51.8%;
  • Mammography in past year: 52.4%;
  • Colonoscopy/sigmoidoscopy (ever): 58.8%;
  • Eye exam with eye doctor in past year: 63.4%;
  • Flu shot in past year: 64.8%;
  • Pneumonia shot (ever): 68.6%;
  • PSA blood test in past year: 72.3%; and
  • Cholesterol test in past year: 85%.
Wide Variations Among Ethnic Groups

The gap between potential care and actual care is particularly large for members of minority groups, where there often already is a pattern of health disparities. This is illustrated by Medicare’s recent release of state-by-state figures for people over 65, the primary group covered by Medicare.

In California, 51.2% of Medicare-age people have hypertension, which can contribute to causing strokes or heart attacks. This includes 77.9% of blacks, 50.2% of whites and 43% of Hispanics.

The incidence of diabetes is 30.7% for Hispanics, 27.9% for blacks and 13.6% for whites.

The health outcome can be devastating: people with diabetes are in much greater danger than the general population of suffering heart attacks, strokes, eye problems, and the risk of circulatory problems that can lead to amputations.

The huge disparities reflect a complex reality: a mixture of genetics, income and access to care before turning 65 and enrolling in Medicare.

The diseases all have interactions, according to Dr. Susan Babey, a research scientist at the UCLA Center for Health Policy Research. For example, one of the biggest risk factors for diabetes is obesity, a condition more prevalent among blacks and Hispanics than among whites, she noted. The incidence of high blood pressure, too, is related to obesity and diabetes.

History of Medicare Coverage for Preventive Care

Medicare’s first offering of preventive services came in 1981 with the vaccine to prevent pneumonia. The rate of vaccination should be close to 100%, especially after a quarter century of promotion and publicity. But it is 59.2% among whites, 38.5% among blacks and 30.2% among Hispanics, according to a federal survey of people older than age 65.

Perhaps the single easiest and most accessible preventive tool is the annual flu shot, which Medicare provides without charge, yet millions of people manage to skip it every year.

“It may be the most basic of services and the single most important one,” Flick said.

About 200,000 people, almost all over the age of 65, are hospitalized in a year from flu complications, and 36,000 of them die.

Outreach Efforts

“The whole thing is about education and getting people involved in their own health care, said Flick, who will be overseeing a bus tour this summer in his region, promoting preventive care events at health fairs and community gatherings.

There also is a new computerized aid, a site on mymedicare.gov where individuals can create a password-protected personal record of their vaccinations and other preventive activities.

Medicare is trying to pound home the message: here are things to take better care of yourself; you should use them. Dr. Ashby Wolfe, acting medical director for CMS region 9, noted that only 52% of women enrolled in Medicare get mammograms to detect breast cancer, and only half the diabetics get regular blood glucose tests.

Medicare officials have been trying different outreach strategies. There was an active enrollment drive for the Part D drug benefit last year involving partnerships with thousands of different groups and organizations, including state and local departments of aging, senior centers, state and local Medicare counseling organizations, and church and community groups.

HHS, which includes the Medicare program, recently announced a special initiative, “Improving Hispanic Elders’ Health: Community Partnerships for Evidence-Based Solutions.”

HHS Secretary Mike Leavitt called the new program an “unprecedented partnership” and said that it “will make it easier for communities to help Hispanic elders, especially those with chronic health conditions and limited resources, to overcome barriers that impede their access to health care and social supports that can improve their health.”

The goal is to increase Hispanic Medicare beneficiaries’ use of prescription drug coverage, flu shots, diabetes screening and self-management, cardiovascular screening, cancer screening services and smoking cessation programs. The initiative will begin with pilot projects in as many as seven metropolitan areas with large Hispanic populations.

Nine communities have been invited to apply for the project, including Los Angeles and San Diego in California. The other potential choices are El Paso, Houston and McAllen, Texas; Miami; Chicago; and New York.

Medicare covers everyone who reaches age 65 and has worked for 10 years under the Social Security system, or is the spouse of an eligible worker. It offers universal health care for older Americans. There are tremendous disparities in chronic health problems among members of minority groups, even with the advent of Medicare.

Patients, Doctors Have To Be Alert

Creating a state of awareness and urgency “can’t be just a government activity,” Wolfe said. “It must be a partnership of everyone in the health care system.”

That means the people enrolled in Medicare have to remember to get their tests and vaccinations and other preventive care, to seek out doctors and get the job done. It means doctors must remind their patients, and nag them if necessary, to take steps for protection and prevention.

Medicare offers universal health care for 40 million Americans — people older than age 65 and people of all ages with disabilities. There are a lot of benefits available. No one should leave any of it untouched on the table of health care.

Prevention is a message too few people enrolled in Medicare have been hearing. If they all start listening, the screening and prevention figures will rise, and the rates of sickness and hospitalization should start falling.

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