Even in Minnesota-considered by some to be the birthplace of managed care-preventive medicine can sometimes fall by the wayside.
Doctors don't keep up with all their patients, and money worries have kept clinics from putting preventive-care delivery systems in place.
Those are some of the findings in a study published in the June issue of Mayo Clinic Proceedings, a journal for Rochester, Minn.-based Mayo Medical Center.
Without specifically naming the Buyers Health Care Action Group, the study points a finger at "a consortium of about two dozen healthcare purchasers" for some of this inattention to preventive services.
Thomas Kottke, M.D., a Mayo Clinic professor of medicine, confirmed the BHCAG was the group in question. Kottke led the five-investigator group that conducted the study.
The employers group is accused of driving down rates. "The fiscal pressures generated by the consortium have led many clinics to feel the need to devote almost all their attention to maintaining solvency," the study said.
It's a charge the buyers group doesn't appreciate. "To draw the conclusion that we are responsible for lower preventive-care rates doesn't make sense to us," said Steve Wetzell, the BHCAG's executive director of policy and public affairs.
Wetzell said his group actively promotes preventive care and doesn't tell doctors what they can charge; rather it asks doctors to determine how much it costs to deliver care. "We're a very visible buyer so we're singled out, even though we don't think it's fair," Wetzell said.
The researchers surveyed 7,997 patients at 44 primary-care clinics in the Minneapolis-St. Paul area, with about 85%, or 6,830 patients, completing the questionnaire. All the information was collected by January 1995, and the project was funded by a federal grant and sponsored by HealthPartners and Blue Plus, two large managed-care organizations in Minnesota.
While the survey takes aim at the BHCAG, Kottke pointed out that some doctors weren't doing preventive services long before the buyers group was formed.
On average, the survey found that at least 60% of the patients reported being up to date on preventive services when they went to see their doctor, except for pneumococcus shots.
But, with the exception of blood pressure screening and advice to stop smoking, less than 30% of patients who weren't up to date on a preventive service were offered it.
The least offered preventive services were pneumococcus shots at 6% and measurement of cholesterol levels at 7%. Highest on the list were Pap smears at 29% and influenza shots at 26%. Breast exams were at 15% and mammograms at 24%.
The survey concluded that unless health plans and purchasers commit to helping practices organize themselves to implement preventive services, their delivery rates aren't going to increase.
"It means there's preventable morbidity and mortality out there that's not being prevented," Kottke said.