Thursday, September 27, 2007
The average physical costs $116, including lab work and X-rays.
SCRIPPS HOWARD
In a medical system with costs ever rising, and the pool of family doctors shallow at best, some experts are beginning to doubt the value of that hallmark of American medicine, the physical, the annual checkup, the look under the hood.
The exams, although they vary in depth and details, usually involve at least a fairly lengthy office visit and assorted tests, depending on medical history, physician hunches and the patient’s desire for thoroughness and ability to pay for it.
This week, for the first time, a team of researchers came up with some definitive numbers about just how widespread the yearly exams are, and how much they cost.
They report in the Archives of Internal Medicine that about 44.4 million U.S. adults, or 21 percent, get a preventive physical exam, while 19.4 million women, or 18 percent, receive a preventive gynecological exam.
Total cost for those services: $5.2 billion for the general checkups and an additional $2.6 billion for the gynecological exams. Even in a system that spends $2 trillion a year on health care, those aren’t tiny amounts.
The data on the visits between Jan. 1, 2002, and Dec. 31, 2004, came from national surveys the federal government periodically does of office-based physicians. Each doctor completes a one-page form detailing his or her encounters with each of 30 randomly selected patients during a particular week.
No formal recommendation
“Although annual exams are not recommended by any major North American clinical organization, our health system is clearly devoting a great deal of time, money and resources to them,” said Dr. Ateev Mehrotra, the lead author of the study, an assistant professor at the University of Pittsburgh School of Medicine and an analyst for the Rand Corp. health think tank.
“Most patients believe they should see a doctor every year for a physical in which the doctor will examine them head to toe and order lots of tests. There are many doctors who disagree. Physicians need to reach greater consensus on what we should advise patients to do.”
The surveys showed that, together, the two types of exams account for about 12 percent of walk-in health care, exceeding those made for either acute respiratory infections or treatment of high blood pressure. The average physical lasts 23 minutes and costs $116, including related lab and X-ray services.
Many exams include batteries of tests, such as complete blood-cell counts or urinalysis, that have not been shown to improve health unless there’s a specific known reason to order them, the surveys show.
“More than a third of annual physicals include potentially unnecessary testing at a cost of more than $350 million a year,” Mehrotra estimated. “That’s nearly the amount of money that the state of Massachusetts is spending annually to provide insurance to the uninsured.”
Moreover, the checkups don’t deliver all that much prevention. The researchers found that 80 percent of preventive care occurs during occasions other than annual exams, and most of the patients were seen by a physician at least once during the same year for some specific complaint.
“This supports the idea advocated by some that we should use other visits as an opportunity to deliver preventive care,” Mehrotra said.
Of course, there are some worthwhile and recommended tests that often don’t happen outside the “well-woman” checkups, such as Pap smears and mammograms.