The task force recommends certain screening,  immunization, and counseling services for people age 65 or older. Most Beneficiaries Receive Some but Not All Recommended Preventive Services

Nationally representative survey data show that Medicare beneficiaries  visit physicians often and that most report receiving “routine checkups.”  These data do not show, however, which specific services were delivered  during those “checkups.” Despite the frequency of visits, many Medicare  beneficiaries do not receive the full range of recommended preventive  services. From 2000 survey data and U. S. Bureau of the Census estimates of people  age 65 or older, we estimated that beneficiaries visited a physician at least  six times that year, on average, mainly for illnesses or medical conditions. Our analysis of additional data for our 2003 report showed  that many Medicare beneficiaries still did not receive certain  recommended preventive services. For example, data from CDC’s NHANES for 1999–2000 show that, of  beneficiaries participating in this nationally representative survey who, as  part of the survey, had a physical examination and were found to have  elevated blood pressure readings at that time, 32 percent reported that no  physician or other health professional had told them about the condition  before. Similarly, 32 percent of those  found by the survey to have a high cholesterol level reported that no one  had told them that they had high cholesterol. Projected nationally, this  percentage translates into 2.1 million Medicare beneficiaries who may  have had high cholesterol without knowing it (see fig. An Initial Examination May Improve Preventive Care, but Follow-up Is Also Key

A one-time initial preventive care examination covered by Medicare may  offer opportunity to deliver some preventive services but alone is not  enough to ensure better health among beneficiaries. It  could be used to orient new beneficiaries to Medicare and encourage them  to make informed choices about providers and plans. Nevertheless, a one- time examination does not ensure delivery of the full range of preventive  services. In the late 1980s and early 1990s, the agency conducted  a congressionally mandated demonstration to test varied health promotion  and disease prevention services, such as free preventive visits, health risk  assessment, and behavior counseling, to see if they would increase use of  preventive services, improve health, or lower health care expenditures for  Medicare beneficiaries. CMS is  exploring an alternative for Medicare preventive care that would provide  systematic health risk assessments to fee-for-service beneficiaries through  a means other than examination by a physician. In addition, the study stated that to be  effective, risk assessment questionnaires must be coupled with follow-up  interventions, such as referrals to appropriate services. A one-time preventive care examination will add a dedicated opportunity  for delivering preventive care and could help reduce the gap in the  preventive services that Medicare beneficiaries receive.
Why GAO Did This Study

Preventive care depends on identifying health risks and on taking steps to control these risks. In contrast, Medicare, the federal health program insuring almost 35 million beneficiaries age 65 or older, was established largely to help pay beneficiaries' health care costs when they became ill or injured. Congress has broadened Medicare coverage over time to include specific preventive services, such as flu shots and certain cancer-screening tests, and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added coverage for several preventive services, including a one-time preventive care examination for new enrollees, which will start in 2005. GAO's work, done before MMA, included analyzing data from four national health surveys to examine the extent to which Medicare beneficiaries received preventive services through physician visits. GAO also interviewed officials from the Centers for Medicare & Medicaid Services (CMS) and other experts and reviewed the results of past demonstrations and studies to assess expected benefits and limits of different delivery options for preventive care, including a one-time preventive care examination.

What GAO Found

Most Medicare beneficiaries receive some but not all recommended preventive services. Our analysis of year 2000 data shows that nearly 9 in 10 Medicare beneficiaries visited a physician at least once that year; beneficiaries made, on average, six visits or more within the year. Still, many did not receive recommended preventive services, such as flu or pneumonia vaccinations. Moreover, many are apparently unaware that they may have conditions, such as high cholesterol, that preventive services are meant to detect. In one 19992000 nationally representative survey where people were physically examined and asked a series of questions, nearly one-third of people age 65 or older whom the survey found to have high cholesterol measurements said they had not before been told by a physician or other health professional that they had high cholesterol. Projected nationally, this percentage translates into about 2.1 million people who may have had high cholesterol without knowing it. A one-time preventive care examination may help orient new beneficiaries to Medicare and provide further opportunity for beneficiaries to receive some preventive services. Covering a one-time preventive care examination does not ensure, however, that beneficiaries will receive the recommended preventive services they need over the long term or consistently improve health or lower costs. CMS is exploring an alternative that would provide beneficiaries with systematic health risk assessments by means other than visits to physicians. A key component of this early effort involves the coupling of risk assessments with follow-up interventions, such as referrals for follow-up care.