By Molly Miller
Reducing Information Asymmetry in Health Care: Medicaid and Medicare Preventive Care Services
There’s a name for the fact that doctors typically know much more about health care services than their patients: information asymmetry. It has and perhaps always will be a barrier to accessing preventive services, especially for low-income and vulnerable populations.
Of course, doctors have more formal training than their patients, a fact that is unlikely to change anytime in the future. But this wealth of knowledge often creates a doctor-patient relationship in which patients rely on their doctor to tell them what health services they need to access. By itself, this is not inherently bad, but when physicians fail to notify their patients of preventive care services that they may be eligible for, this information asymmetry can have dire consequences for a patient’s health outcomes. This is especially true when it comes to Medicare and Medicaid, two insurance programs that are notoriously difficult to navigate.
So what preventive services do Medicare beneficiaries qualify for? More than you would think.
In 2008, Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA), which, among a multitude of other things, provided grants for organizations serving low-income seniors with better access to preventive health care services. These services include:
- A physical exam, completed no more than 12 months after enrollment in Medicare Part B, intended to detect diseases, promote overall health and wellness, and provide referrals to specialists, if needed.
- A variety of preventive and diagnostic screenings, including diabetes screenings (for patients deemed “at-risk”), cardiovascular screenings (once every two years), abdominal aortic aneurism screenings, and screenings for depression.
- Up to four behavioral counseling sessions per year for Medicare beneficiaries who misuse alcohol.
The Affordable Care Act only expanded on these benefits, entitling Medicare beneficiaries to an annual wellness exam in addition to their introductory physical exam and eliminating cost-sharing for a plethora of preventive care services.
But Medicare beneficiaries aren’t the only ones with improved access to preventive care services.
The Affordable Care Act requires insurers to cover a wide array of preventive services and, in those states that have opted to expand Medicaid coverage, those services are now available to Medicaid beneficiaries. These free preventive care services include a variety of screenings for common health problems, such as high-blood pressure and depression; diet counseling for adults with a high-risk for chronic disease; tobacco screening and cessation interventions for tobacco users; and common vaccinations including vaccines for influenza, HPV, and pneumonia.
With the influx of patients receiving insurance coverage because of the ACA, it is vital that physicians and insurers share information about free preventive care services with their patients, regardless of whether or not their patients are Medicaid or Medicare beneficiaries. The more patients know about these services, the more empowered they will be to proactively prevent or manage chronic conditions, thus reducing the overall cost of health care, both for the individual and the provider.