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Partnership for Prevention Survey of Employer Support for Preventive Services

• Counseling to address serious health risks—tobacco use, physical inactivity, risky drinking, poor nutrition—is least likely to be covered by an employer-sponsored health plan. The U.S. Preventive Services Task Force calls these interventions "vitally important."

• Nearly 90 percent of employers' most popular plans cover well-baby care, whereas less than half cover contraceptive devices or drugs to prevent unwanted births. Yet about half of all pregnancies and nearly a third of all births each year are unintended.

• One out of five employer-sponsored plans does not cover childhood immunizations, and one out of four does not cover adolescent immunizations although these are among the most cost-effective preventive services.

SOURCE: IOM (2000a).

to their reduced overall likelihood of receiving clinical preventive services and to their poorer clinical outcomes (Haas and Adler, 2001). For example, African Americans and members of other minority groups who are diagnosed with cancer are more likely to be diagnosed at advanced stages of disease than are whites (Farley and Flannery, 1989; Mandelblatt et al., 1991, 1996; Wells and Horm, 1992).

Medicare Coverage of Preventive Services

Preventive services are important for older adults, for whom they can reduce premature morbidity and mortality, help preserve function, and enhance quality of life. Unfortunately, the Medicare program was not designed with a focus on prevention, and the process for adding preventive services to the Medicare benefit package is complex and difficult. Unlike forms of treatment that are incorporated into the payment system on a relatively routine basis as they come into general use, preventive services are subject to a greater degree of scrutiny and a demand for a higher level of effectiveness, and there is no routine process for making such assessments. Box 5-4 lists the preventive services currently covered by Medicare.

The level of use of preventive services among older adults has been relatively low (CDC, 1998). This may reflect the limited range of benefits covered by Medicare, as well as other barriers such as copayments, participants' unfamiliarity with the services, or the failure of physicians to recom-

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