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20% outpatient visits related to preventive health
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CHICAGO—An estimated 63.5 million U.S. adults visited a physician for a preventive health or gynecological examination each year between 2002 and 2004, at an annual cost of approximately $7.8 billion, according to a report in the September 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.


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“The value of many preventive health services is well established, but the role of preventive health examinations (PHEs) (also called periodic health evaluations) for health promotion and screening of disease risk factors and subclinical illness remains controversial,” the authors write as background information in the article. Two-thirds of patients and physicians believe it is important for patients to receive a yearly check-up; however, strictly preventive general health or gynecological examinations are not recommended by major North American clinical organizations.

Ateev Mehrotra, M.D., M.P.H., of the University of Pittsburgh School of Medicine and RAND Health, Pittsburgh, and colleagues analyzed data from a nationally representative survey of office-based physicians conducted between 2002 and 2004. Randomly selected physicians completed a one-page form detailing their encounters with each of 30 randomly selected patients during an assigned reporting week.

Over the three years of the survey, 181,173 outpatient visits occurred, of which 5,387 were preventive health examinations and 3,026 were preventive gynecological examinations. Nationwide, this is equivalent to 44.4 million adults (20.9 percent of the population) receiving preventive health examinations and 19.4 million women (17.7 percent of adult women) receiving preventive gynecological examinations each year.

The rates of preventive health examinations varied by region, with individuals in the Northeast 60 percent more likely to receive one than those in the West, and by insurance type, with the uninsured half as likely to receive one as those with private insurance or Medicare.

Preventive services such as mammograms, cholesterol screening and smoking cessation counseling were provided at 52.9 percent of preventive health examinations and 83.5 percent of preventive gynecological examinations. However, only 19.9 percent of eight preventive services were provided at these examinations as opposed to other types of physician visits. “For example, mammograms ordered at preventive health examinations and preventive gynecological examinations accounted for 22.9 percent and 44.7 percent of all mammograms, respectively,” the authors write. “In contrast, of all visits with weight reduction counseling, only 8.8 percent were preventive health examinations and 1.1 percent were preventive gynecological examinations.”

“Preventive health examinations and preventive gynecological examinations are among the most common reasons adults see a physician,” they conclude. “These visits frequently include preventive services, but most preventive services are provided at other visits. These findings provide a foundation for continuing national deliberations about the use and content of preventive health examinations and preventive gynecological examinations.”
(Arch Intern Med. 2007;167(17):1876-1883.

Editor's Note: Dr. Mehrotra’s salary was supported by a National Research Service Award from the Health Resources and Services Administration. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .


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