Should That Apple a Day Be Red, Green, or Golden?

The American Medical Association first recommended annual physical examinations of healthy people way back in 1922. Even though the clinical value of prevention was decades away from truly being understood, physicians' sixth sense told them that from the standpoints of morbidity and mortality, it was the right thing to do.

When HMOs burst on the scene half a century later, they, too, embraced the value of prevention — for a different reason: There are many areas where disease prevention is less costly than treatment. Managed care made a bold proclamation that indemnity plans never dared say: “We'll pay to keep you well.”

So if everyone's at least in agreement that preventing illness should be a common goal, why is a mutual understanding of “prevention” so elusive? As this month's cover story illustrates, health plans, employers, and physicians chant prevention, but when seeking guidance they don't always turn to the undisputed bible: the work of the U.S. Preventive Services Task Force.

Some blame is borne by employers, who often expect up-front savings. In other words, if a preventive service adds to premium costs, it's no good — and the benefit's not worth buying.

Political pressures contribute. The National Committee for Quality Assurance, which develops HEDIS measures, had a big row about whether to expand its mammography requirement when it was pressured by HCFA to include women over age 69. Ultimately, NCQA stuck by the USPSTF position that the benefit of routinely screening women 70 and older for breast cancer is uncertain — and left the HEDIS measure unchanged.

Then there's personal responsibility. Truth is, despite all the promotion plans do about prevention, few people seek it. Left to their own devices, only half of women would get annual checkups. Child immunization rates would be in the 60-percent area. At some point, you have to wonder whose problem this really is. One thing is certain: If this country is to become healthier, we need to get on the same page about prevention.