Preventive Care
This was an innovation with HMO's. Traditional insurance never covered it. (After all, if everyone needs the same things, then everyone's premiums have to be that much higher to cover those things, and the insurer takes its percentage off the top before the patients get their money back.)
The theory is that by covering inexpensive preventive care so patients don't hesitate to get proper checkups, the plan saves money on expensive diseases that could have been diagnosed early.
It looked like that would work out in the early days, when HMO's were new and mainly attracted young healthy people whose kids needed baby shots. Now that their enrollees are older, the savings don't look so good.
Early diagnosis may just lead to longer periods of treatment; whereas delayed diagnosis can lead to a rapid and inexpensive death. For instance, someone who dropped dead on the street of a heart attack cost the plan almost nothing, but if his high blood pressure, diabetes and cholesterol had been diagnosed ten years earlier, he might have cost thousands of dollars every year in medications alone.
And ironically, the prescription drug coverage HMO's have made a standard part of health insurance coverage has allowed drug companies to charge skyrocketing prices, knowing that most insured patients won't have to pay the cost out-of-pocket.
©2000 Eileen K. Carpenter, MD