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Medicare to implement new preventive services
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     The Bush administration has given preventive care new emphasis in Medicare, the federal health programme for people aged over 65 years. Under a new Medicare law enacted in 2003, the number of preventive services covered by Medicare will expand, including a comprehensive physical examination for all people enrolling in the programme, to begin in 2005.

    Tommy Thompson, secretary for health and human services, said, "Medicare had it backwards, spending 99% of its resources treating seniors after they got sick and only 1% on preventing illness and promoting wellness. With the new law, we are reversing this trend and focusing more on disease prevention and management."

    When Medicare was enacted in 1965 it provided services only for the diagnosis and treatment of illness or injury. Preventive services were not covered. As the value of preventive services became better understood, Congress amended the Medicare law, through the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, to boost preventive services.

    The Centers for Medicare and Medicaid Services, in its "Welcome to Medicare Physical" scheme, sets out a number of tests not previously covered under Medicare.

    The new law will allow cover for tests for measuring concentrations of total cholesterol, high density lipoprotein, and triglycerides. These tests can be done every five years, as recommended by the independent US Preventive Services Task Force.

    Other preventive services covered by the scheme include vaccination for influenza, pneumococcal pneumonia, and hepatitis B; mammography, cervical smear tests, and pelvic examinations; and screening tests for prostate cancer, colon cancer, glaucoma, and osteoporosis, among other conditions. As part of the initial physical examination Medicare will also pay for an electrocardiogram, assessment of the risk of depression, hearing and vision tests, and a review of a person抯 ability to carry out the activities of daily living, such as bathing, dressing, and eating.

    Under the Balanced Budget Act of 1997, the National Academy of Sciences, together with the US Preventive Services Task Force, analysed the short and long term costs and benefits of expanding preventive services covered by Medicare. The analysis was completed in December 1999.

    A spokesperson for the Centers for Medicare and Medicaid said, "We can demonstrate the benefits of preventive health care services, but we also know that simply offering these services is not always enough to guarantee that Medicare beneficiaries take advantage of the benefits that they provide. taking significant steps to reach out and educate beneficiaries about these new benefits and encourage participation . . . Several initiatives are planned to inform new enrollees about the initial physical exam benefit."

    The administration抯 move comes after a report from the US Government Accountability Office in 2003 showing that, in 2002, 30% of beneficiaries did not receive a flu vaccination, and 37% had never been vaccinated against pneumonia. The report said that adding a routine physical examination benefit to Medicare抯 fee-for-service programme could provide more opportunities for preventive health care, but it would be at increased cost and without guarantee that preventive services would actually be provided to Medicare beneficiaries.

    The administration also announced that Medicare would increase payments to doctors for services covered by the programme by 1.5% next year.

    In autumn the Centers for Medicare and Medicaid Services will send its free Guide to Medicare抯 Preventive Services to all Medicare beneficiaries.(Florida Fred Charatan)