The cost and value of that annual preventative health check up

Even though as many as an estimated 63.5 million American adults visit their doctor for a preventive health or gynecological examination each year, the value of such visits is a controversial issue.

According to a new study such visits cost the nation dearly, somewhere in the region of $7.8 billion annually; but preventive health examinations (PHEs) also called periodic health evaluations, for health promotion and screening of disease risk factors and subclinical illness are not recommended by major North American clinical organizations.

However it seems that two-thirds of patients and their doctors do believe it is important for patients to have a yearly check-up.

The researchers from the University of Pittsburgh School of Medicine and RAND Health Pittsburgh, analyzed data from a nationally representative survey of office-based doctors conducted between 2002 and 2004.

Doctors were randomly selected and then completed a one-page form detailing their encounters with each of 30 randomly selected patients during a designated reporting week.

Researcher Dr. Ateev Mehrotra and his colleagues found that over a three year period there were 181,173 visits, of which 5,387 were preventive health examinations and 3,026 were preventive gynecological examinations.

Extrapolated to a nationwide figure this equates to 44.4 million adults (20.9 percent of the population) receiving preventive health examinations and 19.4 million women (17.7 percent of adult women) receiving preventive gynecological examinations each year.

The researchers found the rates of preventive health examinations varied, with individuals in the northeast 60 percent more likely to receive one than those in the west, and also by insurance type; those who were uninsured were half as likely to receive one as those with private insurance or Medicare.

The researchers say preventive health examinations and preventive gynecological examinations are among the most common reasons adults see a doctor and while such visits frequently include preventive services, most of those are provided at other visits.

Many of the preventive health exams in the study included laboratory tests, such as complete blood cell counts or urinalyses, that do not clearly improve patient outcomes.

Dr. Mehrotra says more than a third of annual physicals include potentially unnecessary testing at a cost of more than $350 million a year, which is almost the same as is spent by the state of Massachusetts annually to provide insurance to the uninsured.

Dr. Mehrotra and his team hope that their findings will inform future recommendations about the frequency of preventive exams and the feasibility of providing one to all adults in the United States on an annual basis.

They say if every adult were to receive a preventive physical exam annually, the U.S. health care system would need to provide up to 145 million more visits every year; that in turn would account for an impractical 41 percent of all time spent on direct patient care by primary care physicians.

Dr. Mehrotra says the research underlines the need to find other means of delivering preventive care beyond annual physicals or to advise some patients they can come in much less frequently.

The researchers say their findings provide a foundation for the continuing national debate about the use and content of preventive health examinations and preventive gynecological examinations.

The research is published in the current issue of Archives of Internal Medicine, one of the JAMA/Archives journals.