[This report will be discussed Wednesday, July 20, at a public briefing beginning at 10 a.m. EDT, in the First Amendment Room of the National Press Club,
Date: July 19, 2011
WASHINGTON — A new report from the Institute of Medicine (IOM) recommends that eight preventive health services for women be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010 (ACA). The ACA requires plans to cover the services listed in the U.S. Department of Health and Human Services' (HHS) comprehensive list of preventive services. At the agency's request, an IOM committee identified critical gaps in preventive services for women as well as measures that will further ensure women's health and well-being.
The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The committee identified diseases and conditions that are more common or more serious in women than in men or for which women experience different outcomes or benefit from different interventions. The report suggests the following additional services:
· screening for gestational diabetes
· human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
· counseling on sexually transmitted infections
· counseling and screening for HIV
· contraceptive methods and counseling to prevent unintended pregnancies
· lactation counseling and equipment to promote breast-feeding
· screening and counseling to detect and prevent interpersonal and domestic violence
· yearly well-woman preventive care visits to obtain recommended preventive services
"This report provides a road map for improving the health and well-being of women," said committee chair Linda Rosenstock, dean,
Deaths from cervical cancer could be reduced by adding DNA testing for HPV, the virus that can cause this form of cancer, to the Pap smears that are part of the current guidelines for women's preventive services, the report concludes. Cervical cancer can be prevented through vaccination, screening, and treatment of precancerous lesions and HPV testing increases the chances of identifying women at risk.
Although lactation counseling is already part of the HHS guidelines, the report recommends comprehensive support that includes coverage of breast pump rental fees as well as counseling by trained providers to help women initiate and continue breast-feeding. Evidence links breast-feeding to lower risk for breast and ovarian cancers; it also reduces children's risk for sudden infant death syndrome, asthma, gastrointestinal infections, respiratory diseases, leukemia, ear infections, obesity, and Type 2 diabetes.
HHS should consider screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes. The
To reduce the rate of unintended pregnancies, which accounted for almost half of pregnancies in the
HHS's guidelines on preventive health services for women will need to be updated routinely in light of new science. As part of this process, HHS should establish a commission to recommend which services health plans should cover, the report says. The commission should be separate from the groups that assess evidence of health services' effectiveness, and it should consider cost-effectiveness analyses, evidence reviews, and other information to make coverage recommendations.
The report addresses concerns that the current guidelines on preventive services contain gaps when it comes to women's needs. Women suffer disproportionate rates of chronic disease and disability from some conditions. Because they need to use more preventive care than men on average due to reproductive and gender-specific conditions, they face higher out-of-pocket costs, the report notes.
The study was sponsored by the U.S. Department of Health and Human Services. Established in 1970 under the charter of the National Academy of Sciences, the
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Pre-publication copies of Clinical Preventive Services for Women: Closing the Gaps are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
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Board on Population Health and Public Health Practice
Committee on Preventive Services for Women
Linda Rosenstock, M.D., M.P.H. (chair)
Department of Family Medicine
Professor of Pediatrics and Health Policy
Department of Pediatrics and Department of Obstetrics, Gynecology, and Reproductive Health Services; and
Philip R. Lee Institute for Health Policy Studies
Jean C. and James W. Crystal Professor of Adolescent Health
Department of Pediatrics and Community Preventive Medicine
Francisco Garcia, M.D., M.P.H.
Distinguished Outreach Professor of Obstetrics and
Gynecology, Public Health, and Pharmacy; and
Cancer Disparities Institute
Vice Chair of Women's Healthcare Quality and Performance Improvement
Department of Obstetrics and Gynecology
Paula A. Johnson, M.D., M.P.H.
Division of Women's Health
Brigham and Women's Hospital
Professor and Senior Research Scientist
Division of Health Policy and Administration
Cecile Usdin Professor in Women's Health and Chair
Department of Community Health Sciences
Medical Informatics and Clinical Epidemiology
Roberta B. Ness, M.D., M.P.H.
Dean and M. David Low Chair in Public Health
Magda Peck, Sc.D.
Associate Dean for Community Engagement and Public Health Practice
E. Albert Reece, M.D., Ph.D., M.B.A.
Vice President for Medical Affairs, John Z. and Akiko K. Bowers Distinguished Professor, and Dean
Vice President and Director of Women's Health Policy
Kaiser Family Foundation
Sally Vernon, Ph.D.
Health Promotion and Behavioral Sciences,
Professorship in Mind-Body Medicine and Public Health, and
Professor of Epidemiology and Behavioral Sciences
Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology, and
Associate Dean for Faculty Affairs
Karen L. Helsing, M.H.S.