By NextBestFitFree preventive care and vaccines
No charges for screening, vaccines, and preventive visits.
Already the rule for ACA preventive services.
Review ledgerHow this path connects
This path
Free preventive care and vaccines
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Cover preventive services without cost sharing
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Prevention and public health are underfunded
Removing charges for screening, vaccines, and preventive visits increases use and provides a simple coverage rule to explain.
What it creates or worsens
- Low-value care and overtreatment
Free screening can increase use of screening that is low-value.
10 paths soften this
Evidence-based coverage decisionsLow-value care and overtreatmentChosenFeedback and clinician nudgesLow-value care and overtreatmentChosenModest copays with an income-based annual capUnderinsurance: covered, but can't afford to use itRejectedValue-based cost sharingUnderinsurance: covered, but can't afford to use itRejectedGlobal budgets for hospitalsU.S. prices are far higher than in other countriesChosenNo-fault compensation for medical injuryMalpractice system: slow, costly, and drives defensive medicineChosenNational health record and patient IDRecords don't follow patientsChosenSeparate public capital budget, planned regionallyUnder-investment in equipment and facilitiesChosenAccept somewhat slower adoptionSlower access to new drugs and technologyRejectedOnly flat, small charges on a few servicesCopays keep billing systems alive and still deter poorer patientsRejected - Raises spending or loosens control over it
Removing charges for preventive services raises costs as use increases.
Who's affected
Who gains
- People who will need care in the future
- Prevention and public health are underfunded: Limited prevention funding leaves chronic disease driving treatment needs.
- People with ongoing or specialist care needs
- Prevention and public health are underfunded: Limited prevention funding leaves chronic disease driving treatment needs.
- Hospitals, clinics, and care organizations
- Low-value care and overtreatment: Per-service payments reward additional low-value care.
- Drug and device makers
- Low-value care and overtreatment: They sell devices and tests used in low-value care.
Who loses
- Hospitals, clinics, and care organizations
- Prevention and public health are underfunded: More chronic disease creates more treatment business.
- People with ongoing or specialist care needs
- Low-value care and overtreatment: Low-benefit tests and treatments expose them to harm.
- Health insurers, brokers, and their shareholders
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Taxpayers and public budgets
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Raises spending or loosens control over it: Public budgets pay the added spending.
Where it has been tried
- U.S. ACA: Under the ACA, over 150 million privately insured Americans (plus 20 million Medicaid expansion enrollees and 61 million on Medicare) have access to recommended preventive care and vaccines without cost sharing (2022).Sources: ASPE (HHS) (2022)