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Paying for prevention.

An ounce of prevention may be worth many pounds of cure, especially if the cost of health care services continues to escalate at its present rate. With only about 2 percent of our national annual cost of health care being spent on preventive services, apparently most Americans are missing out on preventive measures other than those they can provide for themselves (i.e., diets, exercise, etc.).

One reason, of course, is cost. Most traditional health insurance policies do not provide preventive services; therefore, many persons are unwilling to pay for these services themselves. In areas where health maintenance organizations (HMOs) are available, employees of larger companies often have a choice between traditional insurance, which may or may not pay for preventive services, or membership in an HMO. Most HMOs are quite generous in providing these services. Only about 14 percent of persons living in the United States belong to HMOs, however, and another 17 percent have no insurance at all.

Just as preventive self-care is each person's own responsibility, therefore, so is professional preventive care for most of us--and we simply have to budget for it. Most of us, however, are not really sure just what we need and how often we need it, and many are spending money on routine "checkups" each year or two that often include things we don't need. Regular chest x-rays and complete blood counts, for example, are no longer recommended in routine medical exams simply because they are not worth the cost. Nor do all of us need the same thing--age, sex, and personal and family medical histories are determining factors.

Here, then, are some guidelines for preventive health care, as determined by the U.S. Preventive Services Task Force:

(1) Everyone should have regular blood pressure checks--not less than once every two years for healthy adults;

(2) Everyone should have a booster shot of tetanus/diphtheria vaccine every 10 years;

(3) Everyone over 65, nursing home residents, and others at high risk (e.g., chronic lung disease) should be immunized annually against influenza;

(4) Everyone over 65 should receive a pneumococcal vaccine at least once;

(5) Every adult should be screened for cholesterol levels, at intervals recommended by one's physician, depending upon family history of heart disease, smoking habits, etc.;

(6) Everyone over 65 should be screened for glaucoma, at intervals recommended by one's physician, as well as others at risk (e.g., near-sighted individuals);

(7) Everyone over 50 with a family history of colon cancer and anyone with inflammatory bowel disease or intestinal polyps should have a sigmoidoscopy exam at physician-recommended intervals;

(8) All women from age 18 onward, or at onset of sexual activity if earlier, should have a Pap smear every one to three years, depending on risk factors, such as smoking or the presence of genital warts;

(9) All women should have a mammogram at age 35, every two years thereafter from 37 to 50, and annually thereafter;

(10) All women over 40 should have a professional breast exam annually.

Note: Pregnant women, infants, and children are not covered by these recommendations, since they require continuing professional health surveillance to determine their individual requirements.
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Title Annotation:guidelines for professional preventive health care
Publication:Medical Update
Date:Jun 1, 1991
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