Problems that arise when preventive medicine services waive co-pays

by Jeoffry B. Gordon, MD, MPH

Preventive medicine services will soon require no co-pays.

This is just another example of how complex and fouled up any health reform that depends on commercial insurance can be. In addition it demonstrates how pious morality infused into the democratic politics of health reform impairs the greater good.

So after all current insurance policies renew, according to Affordable Care Act, preventive services must be provided without co-pay — i.e. be free at the point of service.

Let’s look at three impending problems:

  1. Well women exams and pap smears are preventive medicine. If the visit then results in contraceptive advice or a birth control prescription does this become a medical service (and subject to copay)  even though no disease is treated? Who will decide this and how will it be done?
  2. Co-pays are now so substantial that they induce a significant number of patients to fore go medically needed care. So when a patient schedules a “preventive medicine visit” and then pours forth a bunch of significant symptoms, which obviously require care and attention, should the doc go back and see if a copay was made or even worse get into a possibly contentious discussion with the patient about requiring an (unexpected) copay? What does this do to the doctor patient relationship?
  3. Say I am a pediatrician and I see 20 patients a day, including 6 well child visits. If an average insurance copay is now $20, the new law means I will be foregoing $120 per day or $28,800 per year. This is a substantial amount. In this day and age when insurance companies are responding to a multitude of mandated cost accelerating mandates and are routinely squeezing physician reimbursements anyway, it is unlikely that they will be taking any initiative to raise any fees or payments to the doctor to make up for this forgone income. Thus the direct effect of this reform will be to make the patient’s incentive for preventive care an  expense to the providing physician. Most docs will not curtail preventive medical care because of this, but this is certainly demoralizing and certainly not an inducement for providers to expand preventive services.

Jeoffry B. Gordon is a family physician.

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