Managed care always couched its emphasis on prevention with the caveat that diagnostic tests should be conducted according to generally accepted national practice guidelines. A new study seems to indicate just how costly preventive medicine can be when not tied to a disciplined approach.

Unneeded medical tests directly cost the health care system millions of dollars a year, according to a study in the American Journal of Preventive Medicine. Costs balloon when a test result is false positive, says the study's lead author, Dan Merenstein, MD, an assistant professor in the department of family medicine at Georgetown University Medical Center.

"We estimate that if 20 percent of EKGs are false, the follow-up tests will cost about $683 million, and that doesn't account for the stress that a patient feels, the time off from work they have to take, and the possible complications . . .," says Merenstein.

Merenstein and his researchers analyzed 4,617 doctor visits by adults over 20. They reviewed tests in light of recommendations by the United States Preventive Services Task Force, which is a panel of experts that grades preventive screening measures based on evidence of effectiveness.

Researchers found that inappropriate use of urinalysis, EKG, and X-rays cost the system between $47 million and $194 million a year.

Inappropriate use of two kinds of blood-screening procedures cost an additional $12 million to $63 million a year.

"Many physicians, as well as their patients, appear to believe that a routine health exam should include a number of tests they feel can screen for unknown diseases, but the evidence shows that some of these tests are less than beneficial when used this way," says Merenstein.

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