摘要：The Affordable Care Act requires many health plans to provide coverage for certain recommended clinical preventive services without charging copays or deductible payments. This provision could lead to greater uptake of many services that can improve health and save lives. Although the coverage provision is broad, there are many caveats that also apply. It is important for providers and public health professionals to understand the nuances of the coverage rules to help maximize their potential to improve population health. Every year, more than 100 000 additional lives could be saved if more people received recommended preventive care. 1 In fact, preventive health care services—such as cancer screenings, tobacco cessation interventions, and vaccinations—can help prevent 9 of the top 10 leading causes of death ( Table 1 ). Cost is frequently cited as a barrier to receipt of needed care. 3 To that end, as of September 2010, the Affordable Care Act (ACA) 4 requires many health plans to provide in-network coverage for certain recommended clinical preventive services, along with prevention-only office visits, without charging copays or deductible payments (§1001). 4 This requirement provides an opportunity to affect population health by increasing the uptake of lifesaving services. Providers, insurers, and public health agencies can work together to ensure that people know what preventive care they need and which services are free. However, achieving these aims is complicated and merits a more thorough understanding of the coverage without copay or deductible requirement for preventive care. TABLE 1— Leading Causes of Death: United States, 2010 Cause of Death No. of Deathsa Selected Preventive Service(s) Available Heart disease 597 689 Blood pressure screening, cholesterol screening, aspirin chemoprophylaxis, tobacco cessation, etc. Cancer 574 743 Cervical cancer screening, colorectal cancer screening, breast cancer screening, skin cancer risk reduction, etc. Chronic lower respiratory diseases 138 080 Tobacco cessation interventions and influenza and pneumococcal vaccinations Stroke (cerebrovascular diseases) 129 476 Blood pressure screening, cholesterol screening, aspirin chemoprophylaxis, tobacco cessation, etc. Accidents (unintentional injuries) 120 859 Falls prevention Alzheimer’s disease 83 494 None Diabetes 69 071 Obesity screening and counseling, healthy diet counseling, diabetes screening, etc. Nephritis, nephrotic syndrome, and nephrosis 50 476 Blood pressure screening, diabetes screening, Hepatitis C screening, Hepatitis B vaccination, etc. Influenza and pneumonia 50 097 Influenza and pneumococcal vaccinations Intentional self-harm (suicide) 38 364 Depression screening Open in a separate window aNumber of deaths obtained from Heron. 2
