Preventive Health Examinations and Preventive Gynecological Examinations in the United States

Published in: Archives of Internal Medicine, v. 167, no. 17, Sep. 24, 2007, p. 1876-1883

Posted on RAND.org on January 01, 2007

by Ateev Mehrotra, Alan M. Zaslavsky, John Z. Ayanian

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BACKGROUND: Preventive health examinations (PHEs) are controversial, and limited data are available on their use and content. METHODS: The authors conducted a retrospective analysis of 8413 ambulatory visits from January 1, 2002, to December 31, 2004, for PHEs and preventive gynecological examinations (PGEs) by adults in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Population estimates were obtained from the Current Population Survey. The authors estimated rates of PHEs and PGEs by patients' demographic characteristics, the frequency of 8 preventive services provided at these visits, and total costs of PHEs and PGEs at Medicare reimbursement rates. RESULTS: An estimated 44.4 million adults per year (20.9%; 95% confidence interval [CI], 18.2%-23.6%) received a PHE, and 19.4 million women per year (17.7% of adult women; 95% CI, 14.9%-20.4%) received a PGE, together accounting for 8.0% of all ambulatory visits. The PHE rates varied by region (Northeast vs West: relative risk, 1.58; 95% CI, 1.17-2.14) and insurance type (those without vs those with private insurance or Medicare: relative risk, 0.51; 95% CI, 0.40-0.65). Preventive services occurred at 52.9% (95% CI, 48.8%-57.0%) of PHEs and 83.5% (95% CI, 80.7%-86.3%) of PGEs, but only 19.9% (95% CI, 18.4%-21.5%) of 8 preventive services occurred at a PHE or PGE. The annual costs of these visits were approximately $7.8 billion. CONCLUSIONS: PHEs and PGEs 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 PHEs and PGEs.

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