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State of the Union health care proposals must include provisions for preventive care, U-M experts say

Any cash-based changes must include provisions for preventive care, they say

University of Michigan Health System

University of Michigan researchers who have studied the impact of out-of-pocket health costs on Americans' behavior are available to comment on new 'consumer-driven health care' proposals that President George W. Bush is expected to unveil in his State of the Union address on Tuesday evening.

While the details of those plans are not known, they are expected to involve more emphasis on individual cash accounts and cash expenditures for health care, in exchange for tax breaks or other incentives.

If so, the researchers say, any plan to increase the consumer's role in health spending must also include a way to ensure that consumers get essential, proven preventive care for little or no money of their own.

These include medications and tests that have been proven to save money in the long run, by preventing the progression of problems or spotting them early. They include screening high-risk individuals for cancer, cholesterol-lowering drugs for people who have survived a heart attack, vaccines for children, and certain medicines and tests for people with diabetes mellitus.

Research at U-M and elsewhere has shown that the more money people have to pay out of their own pockets to get such care, the less likely they are to actually take the medicines or have the tests done. And that increases the risk of more expensive -- and preventable -- problems down the road.

"Involving consumers in making their own health care spending decisions is important and will likely save money at least in the short term," says A. Mark Fendrick, M.D., co-director of the U-M's Center for Value Based Insurance Design and a professor in the U-M Medical School and U-M School of Public Health. "But most of the discussion regarding consumer-directed health plans fails to address the fact that increasing out-of-pocket expenditures will lead to decreased utilization of essential health care services. We need to create a system that will remove financial barriers for those clinical services where there is clear evidence of value."

Fendrick, along with fellow researchers Michael Chernew, Ph.D., John Piette, Ph.D., and Allison Rosen, M.D., MPH, Sc.D., of the U-M Medical School and U-M School of Public Health have all studied how people change their medicine-taking habits and other health behaviors depending on how much cash they have to pay.


For more on their research, or to reach them for comment, call 734-764-2220.

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