Preventive Care Does Not Want To Be “Free”

One conceit behind Obamacare is that if the government mandates preventive care be “free”, people will use it. The notion should appeal to free-market types, too: As the price of a service drops, the quantity demanded should increase.

However, it is not that simple in health care. Let’s take another dive into the always heated and controversial discussions about preventive care for women (such as our recent entry about mammography).

New research shows that women under 65 are over screened for osteoporosis, and women aged 65 and over are under screened, although older women get screened for “free”:

Osteoporosis screening rates jumped sharply at age 50, despite guidelines suggesting that screening only begin at age 65, unless a woman has certain risk factors.

However, the study also found that those risk factors — a small body frame, a history of fractures, or taking medications that could thin bones — had only a slight effect on a woman’s decision to get her bones tested.

Over seven years, more than 42 percent of eligible women aged 65 to 74 were not screened, Amarath’s team found, nor were nearly 57 percent of those older than 75.

However, nearly 46 percent of low-risk women aged 50 to 59 were screened, as were 59 percent of low-risk women aged 60 to 64.

Women are clearly not responding solely to financial incentives for screening. Under Obamacare’s Essential Health Benefits, osteoporosis screening is only indicated as “free” preventive care for women over 60 with certain risk factors. For women on Medicare (that is, most women 65 and older), screening is “free”.

And yet, the actual incidence is upside down. Mandating “free” coverage of preventive care does not predict an increase in appropriate use.

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