HLTH 4350 Walden University Healthcare Economics from a Population Health Perspective PPT & Essay

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Assignment: Connecting Health Outcomes, Epidemiology, and Perspectives of EconomicsThe principles of epidemiology focus on public health and the measurement factors of interest for health professionals to detect associations and determine population risk. Zika, HIV, Influenza, infant morbidity, and mortality are examples of public health concerns that epidemiologists track, trend, and report. It is important to note that although some populations may appear similar geographically or demographically, when tracking epidemiological trends, populations may appear to vary significantly between states or even between counties within those states.This Assignment has two parts:Part 1: PowerPoint PresentationPart 2: Executive Summary Prepare an Executive Summary of your findings regarding the impact of social determinants of health on health outcomes.To Prepare:Select two counties in the same state that are not similar demographically to focus on. You may want to consider the county you live or work in as one of the two counties.Access the National Environment Public Health Tracking Network from this week’s Learning Resources.Enter the following parameters:Content Area: Select Heart DiseaseIndicator: Select Mortality RateMeasure: Select Age Adjusted Death RateGeographical Level: Select State by County (Data Smoothed)Select a state for your data.Select the most recent year availableSelect all races/ethnicities availableCompare the heart attack mortality rate/100,000 people for the two counties you selected.You can view the data as a map, chart, or table. The row that has the data of interest will allow you to select the view you want.Select the table view, and the click the down arrow to download the table.Open the table, and save an Excel file (.xlsx).Review the data you obtain for the two counties you selected.Reflect on the results that you obtain for different ethnic groups within the counties you selected.Access the map of uninsured rates by the U.S. Census Bureau (2015) provided in this week’s Learning Resources.Review and reflect on the uninsured rates for the congressional districts for the counties you selected. Part 1: PowerPoint PresentationPrepare a 5- to 6-slide PowerPoint presentation that addresses the following:Explain the trends you observe between each of the counties you selected.Research and explain the social determinants of health for heart disease for the counties you selected. Be specific, and provide examples.You can use the Excel sheet you saved during your data search on one of the slides. Write 2-3 comments about the data.You may also choose to do research using online databases, like the CDC and WHO, or by speaking with local health professionals. Be sure to reference and cite your sources accordingly.What resources for addressing heart disease may be lacking in one county compared to the other?Describe whether the number of insured persons over the last 5 years has increased or decreased for your counties.Do health outcomes over this same time frame correlate with this trend? Explain your response.Is there a correlation between the levels of health insurance coverage, healthcare costs, or healthcare access and the health outcomes you observed?As a healthcare leader in the state you selected, recommend at least one program that might improve the health of the population, and explain why. Be specific, and provide examples.Part 2: Executive SummaryCreate a 2- to 3-paragraph summary of your findings that addresses the following:Be sure to include how the social determinants of health (SDOH) have impacted the health outcomes of the members of the population you researched, as well as the impact to economics perspectives.Use the questions you addressed in the PowerPoint as a guide.PLEASE CHOOSE THE COUNTIES OF U.S. STATES. Preferably, counties in South Dakota. For example, Minnehaha County and Union County.Resources:https://ephtracking.cdc.gov/DataExplorer/#/https://www.cdc.gov/vitalsigns/cardiovascular-disease.htmlhttp://www.credoeconomics.com/wp-content/uploads/2017/02/credo.pdfhttps://www2.census.gov/programs-surveys/demo/visualizations/p60/257/Map_Uninsured_Rate_by_CD_2015.pdf

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Preventive Care:
A National Profile on Use, Disparities, and Health Benefits
Preventive Care:
A National Profile on Use, Disparities, and Health Benefits
Table of Contents
Letter from the Chair of the National Commission on Prevention Priorities,
Dr. Eduardo Sanchez
1
Acknowledgments
2
Report Highlights
6
Introduction
9
Prevention: A Key Indicator of Quality
12
Use of High-Value Preventive Services and Lives Saved If Use of Services Improved
15
Disparities in Use of High-Value Preventive Services
32
Cancer Screening: Lives Saved If Screenings Were Increased among Racial and
Ethnic Groups
36
Appendix: Data Sources and Gaps on Use of 25 Clinical Preventive Services for
General State or National Populations
41
Copyright © 2007 Partnership for Prevention®. All rights reserved.
August 7, 2007
Dear Colleague:
This report brings attention to the importance of high-value preventive care. This type of care
includes immunizations, disease screenings, and counseling services delivered by health care
providers—services that produce the greatest health benefits and offer the best cost value based
on extensive research to determine the best evidence for what works in prevention. This report
documents the shortfalls in use of these health care services and the life-and-death consequences.
It also features the mortality impact of under-use of cancer screening services for racial and ethnic
populations. This report’s singular focus on prevention and health impact data make it unique.
The sad fact is that high-value preventive care is widely underused, and as a result there are
millions of people whose lives are shortened or who are unnecessarily sick, who are less productive
than they would be otherwise, and who incur expensive medical costs. Closing the gaps in the use
of just five preventive services would save 100,000 lives annually in the United States.
For example, increasing the number of adults who use aspirin regularly to prevent heart disease
would save 45,000 lives annually. Increasing the percentage of smokers who have had a doctor
offer assistance to help them quit would save 42,000 lives annually. These two preventive measures
have been recommended by experts for years. Yet the majority of people who need to use aspirin
regularly for prevention purposes are not using it, and the majority of smokers who need medical
assistance to quit are not getting that help from their doctors. Any effort to reform the nation’s
health system should have greater use of these and other evidence-based preventive services as a
front-and-center goal.
I urge you to read and discuss this report with your colleagues, bring it to the attention of
policymakers and those who influence them, and do your part to implement the policies and
practices necessary to make improvements.
Sincerely,
Eduardo Sanchez, MD, MPH
Chair, National Commission on Prevention Priorities
1
Acknowledgments
The National Commission on Prevention Priorities (NCPP) is convened by Partnership for
Prevention® and guides the work found in this report. The NCPP aims to give decision-makers
(1) evidence-based information about which preventive services offer the greatest health impact
and are most cost effective, (2) guidance about where improving delivery rates will offer the
greatest returns on investment, and (3) a resource for building demand for a prevention-focused
health care system.
Partnership for Prevention formed the NCPP in 2003 to guide a study ranking the relative value
of 25 clinical preventive services for the U.S. population. Former Surgeon General David Satcher
chaired the NCPP from 2003 until the rankings were published in the American Journal of
Preventive Medicine in 2006. Dr. Eduardo Sanchez began as chair of the NCPP in 2007 to guide
continued work on prevention priorities, including analyses of priorities for specific population
groups. The NCPP’s website is www.prevent.org/NCPP.
Sponsors
Partnership for Prevention, HealthPartners Research Foundation, and the NCPP gratefully
acknowledge support from Centers for Disease Control and Prevention, Robert Wood Johnson
Foundation, and WellPoint Foundation. The opinions expressed in this report are solely those
of the authors and not of the sponsors.
Prevention Priorities Staff
Partnership for Prevention, Washington, DC
Ashley B. Coffield, Co-Principal Investigator
John M. Clymer, President
Natalie May, Senior Administrative Coordinator
HealthPartners Research Foundation, Minneapolis, MN
Michael Maciosek, Co-Principal Investigator
Nichol Edwards, Project Manager
Thomas Flottemesch, Economist/Statistician
Louise Anderson, Health Services Researcher/Actuary
Dana McGree, Assistant Project Manager
Amy Butani, Programmer
Leif Solberg, Senior Medical Advisor
2
National Commission on Prevention Priorities
Chair
Eduardo Sanchez, MD, MPH
Director, Institute for Health Policy
University of Texas School of Public Health
Members
M. Blake Caldwell, MD, MPH
Strategy and Innovation Officer and Healthy Healthcare Goal Team Leader
Coordinating Center for Infectious Disease
Centers for Disease Control and Prevention
Carolyn Clancy, MD
Director
Agency for Healthcare Research and Quality
Kevin Fenton , MD , PhD
Director, National Center for HIV, STD, and TB Prevention
Centers for Disease Control and Prevention
David W. Fleming, MD
Director of Public Health
Seattle and King County Washington
Jonathan E. Fielding, MD, MPH , MBA
Director and Health Officer
County of Los Angeles Department of Public Health
James R. Gavin, III, MD, PhD
President and Chief Executive Officer
MicroIslet, Inc.
Anne C. Haddix, PhD
Chief Policy Officer
Office of Strategy and Innovation Development
Centers for Disease Control and Prevention
3
George Isham , MD
Medical Director and Chief Health Officer
HealthPartners
Lovell Jones, PhD
Director of the Center for Research on Minority Health
University of Texas MD Anderson Cancer Center
Warren A. Jones, MD
Executive Director
Mississippi Institute for Improvement of Geographic Minority Health
Distinguished Professor of Health Policy
University of Mississippi Medical Center
Lawrence S. Lewin, MBA
Executive Consultant
James Marks, MD, MPH
Senior Vice President & Director, Health Group
Robert Wood Johnson Foundation
Samuel Nussbaum , MD
Chief Medical Officer
Wellpoint, Inc.
C. Tracy Orleans, PhD
Distinguished Fellow and Senior Scientist
Robert Wood Johnson Foundation
Marcel Salive, MD, MPH
Director, Division of Medical and Surgical Services
Coverage Analysis Group
Centers for Medicare and Medicaid Services
Anne Schuchat, MD
Director, National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Patricia Smith
President and CEO
Alliance of Community Health Plans
4
Steve Solomon, MD
Director, Coordinating Center for Health Information and Services
Centers for Disease Control and Prevention
Arthur Southam, MD
Executive Vice President, Health Plan Operations
Kaiser Foundation Health Plan, Inc.
Kurt C. Stange, MD, PhD
Editor, Annals of Family Medicine
Professor of Family Medicine, Epidemiology & Biostatistics, Oncology and Sociology
Case Western Reserve University
Steven M. Teutsch, MD, MPH
Executive Director
Outcomes Research and Management
Merck & Company
Kathleen Toomey, MD
Director, Coordinating Center for Health Promotion
Centers for Disease Control and Prevention
Cristie Travis, MS
Chief Executive Officer
Memphis Business Group on Health
Carlos A. Ugarte, MSPH
Senior Public Health Advisor
National Council of La Raza
Robert O. Valdez, PhD
Senior Scientist
RAND Corporation
Steven H. Woolf, MD, MPH
Professor, Departments of Family Practice, Preventive Medicine and Community Health
Virginia Commonwealth University
5
Report Highlights
This report demonstrates that there is significant underuse of effective preventive care in the
United States, resulting in lost lives, unnecessary poor health, and inefficient use of health care
dollars. All of the services examined in this report are extremely cost effective: they all provide an
excellent return on investment. It is a national imperative to make these and other cost-effective
preventive services affordable and accessible for all Americans.
Following up on the National Commission on Prevention Priorities’ rankings that demonstrate
the most valuable preventive services for the U.S. population, this report
yy Documents the use of preventive care across the United States;
yy Estimates the health benefits for the U.S. population of increasing the use of preventive
services from current utilization rates to 90 percent;
yy Quantifies disparities in use of preventive care by comparing the use of services by racial
and ethnic groups to the white, non-Hispanic population; and
yy Gives special attention to cancer screenings by estimating the lives that would be saved if
breast, cervical, and colorectal cancer screening rates increased from current screening rates
to 90 percent among racial and ethnic groups.
Highlights of the report’s findings follow:
LOW USE OF PREVENTIVE CARE COSTS LIVES
Utilization rates remain low for preventive services that are very cost effective and have been
recommended for years. Increasing the use of just 5 preventive services would save more than
100,000 lives each year in the United States.
yy 45,000 additional lives would be saved each year if we increased to 90 percent the portion of
adults who take aspirin daily to prevent heart disease. Today, fewer than half of American
adults take aspirin preventively.
yy 42,000 additional lives would be saved each year if we increased to 90 percent the portion
of smokers who are advised by a health professional to quit and are offered medication or
other assistance. Today, only 28 percent of smokers receive such services.
yy 14,000 additional lives would be saved each year if we increased to 90 percent the portion of
adults age 50 and older who are up to date with any recommended screening for colorectal
cancer. Today, fewer than 50 percent of adults are up to date with screening.
yy 12,000 additional lives would be saved each year if we increased to 90 percent the portion of
adults age 50 and older immunized against influenza annually. Today, 37 percent of adults
have had an annual flu vaccination.
6
yy 3,700 additional lives would be saved each year if we increased to 90 percent the portion
of women age 40 and older who have been screened for breast cancer in the past 2 years.
Today, 67 percent of women have been screened in the past 2 years.
ƒƒ?Breast and cervical cancer screening rates were lower in 2005 compared to five years
earlier for every major racial and ethnic group: White, Hispanic, African American
and Asian women all experienced declines.
yy 30,000 cases of pelvic inflammatory disease would be prevented annually if we increased
to 90 percent the portion of sexually active young women who have been screened in the
past year for chlamydial infection. Today, 40 percent of young women are being screened
annually.
RACIAL AND ETHNIC DISPARITIES IN USE OF PREVENTIVE CARE
In several important areas, use of preventive care among racial and ethnic groups lags behind
that of non-Hispanic whites.
yy Hispanic Americans have lower utilization compared to non-Hispanic whites and African
Americans for 10 preventive services.
ƒƒ?Hispanic smokers are 55 percent less likely to get assistance to quit smoking from a
health professional than white smokers.
ƒƒ?Hispanic adults age 50 and older are 39 percent less likely to be up to date on colorectal
cancer screening than white adults.
ƒƒ?Hispanic adults age 65 and older are 55 percent less likely to have been vaccinated
against pneumococcal disease than white adults.
yy Asian Americans have the lowest utilization of any group for aspirin use as well as breast,
cervical and colorectal cancer screening.
ƒƒ?Asian men age 40 and older and women age 50 and older are 40 percent less likely to
use aspirin to prevent heart disease than white adults.
ƒƒ?Asian adults age 50 and older are 40 percent less likely to be up to date on colorectal
screening than white adults.
ƒƒ?Asian women ages 18 to 64 are 25 percent less likely to have been screened for cervical
cancer in the past 3 years than white women.
ƒƒ?Asian women age 40 and older are 21 percent less likely to have been screened for
breast cancer in the past two years than white women.
yy Despite higher screening rates among African Americans for colorectal and breast cancer
compared to Hispanic and Asian Americans, increasing screening in African Americans
would have a bigger impact on their health because they have higher mortality for those
conditions.
7
ƒƒ?If the 42 percent of African Americans age 50 and older up to date with any
recommended screening for colorectal cancer increased to 90 percent, 1,800 additional
lives would be saved annually. This is a rate of 26 per 100,000 African Americans age
50 and older, substantially more than the corresponding rates of 17, 15, and 15 per
100,000 additional lives saved for whites, Hispanics, and Asians, respectively.
CONCLUSION
Low utilization rates for cost-effective preventive services reflect the lack of emphasis that our
health care system currently gives to providing these services. Among the 12 preventive services
examined in this report, 7 are being used by about half or less of the people who should be using
them. Racial and ethnic minorities are getting even less preventive care than the general U.S.
population.
Expanding the delivery of preventive services of proven value would enable millions of Americans
to live longer, healthier, and more fulfilling lives. There is the potential to save more than 100,000
lives annually by increasing use of just 5 preventive services. It would also lead to more effective
use of the nation’s resources because the United States would get more value—in terms of
premature death and illness avoided—for the dollars it spends on health care services.
8
Introduction
In 2006, Partnership for Prevention® and HealthPartners Research Foundation, under the
guidance of the National Commission on Prevention Priorities, published a study1 that ranked
25 evidence-based clinical preventive services recommended by the U.S. Preventive Services Task
Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP).2 Services were
ranked based on each service’s health benefits and economic value.
Clinical preventive services are immunizations, disease screenings, and behavioral counseling
interventions delivered to individuals in clinical settings for the purpose of preventing disease or
initiating early treatment for conditions that are not yet apparent.
The study identified clinical preventive services that:
yy Are most valuable, i.e., that could prevent the greatest amount of disease and premature
death in the U.S. population and that are most cost-effective, and
yy Would prevent the most disease and premature death in the U.S. population were utilization
rates increased from current utilization rates up to 90%.
How Preventive Services Were Ranked: The health benefits of preventive services were
defined as clinically preventable burden (CPB), or the disease, injury or premature death that
would be prevented if the service were delivered to all people in the target population. The
economic value of preventive services was measured as cost effectiveness (CE), which compares
the net cost of a service to its health benefits. CE provided a standard measure for comparing
services’ return on investment. Services that produce the most health benefits received the highest
CPB score of 5. Services that were most cost effective received the highest CE score of 5. Scores
for CPB and CE were then added to give each service a possible total score between 10 and 2.
1
Maciosek MV, Coffield AB, Edwards NM, Goodman MJ, Flottemesch TJ, Solberg LI. Priorities among effective clinical preventive services: results
of a systematic review and analysis. Am J Prev Med 2006; 31(1):52-61.
2
Only evidence-based services as determined by the USPSTF or ACIP were included in the rankings (see related side bar on page 11). Services
delivered by specialists were not included unless initiated by a primary care clinician.
9
Rankings of Clinical Preventive Services for the U.S. Population
CPB
CE
Total
Discuss daily aspirin use—men 40+, women 50+
5
5
10
Childhood immunizations
5
5
Smoking cessation advice and help to quit—adults
5
5
Alcohol screening and brief counseling—adults
4
5
9
Colorectal cancer screening—adults 50+
4
4
8
Hypertension screening and treatment—adults 18+
5
3
Influenza immunization—adults 50+
4
4
Vision screening—adults 65+
3
5
Cervical cancer screening—women
4
3
Cholesterol screening and treatment—men 35+, women 45+
5
2
Pneumococcal immunizations—adults 65+
3
4
Breast cancer screening—women 40+
4
2
Chlamydia screening—sexually active women under 25
2
4
Discuss calcium supplementation—women
3
3
Vision screening—preschool children
2
4
Folic acid chemoprophylaxis—women of childbearing age
2
3
Obesity screening—adults
3
2
Depression screening—adults
3
1
Hearing screening—adults 65+
2
2
Injury prevention counseling—parents of children 0-4
1
3
Osteoporosis screening—women 65+
2
2
Cholesterol screening—men < 35, women < 45 at high risk 1 1 Diabetes screening—adults at risk 1 1 Diet counseling—adults at risk 1 1 Tetanus-diphtheria booster—adults 1 1 Notes: Services with the same total score tied in the rankings: 10 = highest impact, most cost effective among these evidence-based preventive services 2 = lowest impact, least cost effective among these evidence-based preventive services This is a ranking of what doctors can do in their offices to prevent disease and promote health, not what people can do in their personal lives, such as increasing exercise levels or eating a healthier diet. Go to www.prevent.org/ncpp for complete information. See the appendix to this report for more complete descriptions of all 25 services. 10 7 6 5 4 2 What Works in Preventive Care? The U.S. Preventive Services Task Force, The Advisory Committee on Immunization established by the federal government in 1984, Practices, whose members are selected by the determines the effectiveness of a wide range of Secretary of the U.S. Department of Health clinical preventive services initiated by primary and Human Services, evaluates the clinical care clinicians based on a rigorous, evidence- appropriateness of immunizations. based assessment. www.cdc.gov/vaccines/recs/acip www.preventiveservices.ahrq.gov This report is a follow-up to the 2006 rankings. The NCPP aims to bring attention to those highimpact, cost-effective preventive services that have the lowest utilization rates and the greatest potential to save lives if utilization rates improved. Thus, this report yy Documents the use of preventive care across the United States; yy Estimates the health benefits for the U.S. population of increasing the use of preventive services from current utilization rates to 90 percent;3 yy Quantifies disparities in use of preventive care by comparing use of services by racial and ethnic groups to the white, non-Hispanic population; yy Gives special attention to cancer screenings by estimating the lives that would be saved if breast, cervical and colorectal cancer screening rates increased from current screening rates to 90 percent among selected racial and ethnic groups.4 3 Lives saved were estimated using models previously developed to rank clinical preventive services. See Maciosek MV, Edwards NM, Coffield AB, Flottemesch TJ, Nelson WW, Goodman MJ, Rickey DA, Butani AB, Solberg LI. Priorities among effective clinical preventive services: methods. Am J Prev Med 2006; 31(1):90-96. 4 We further developed our cancer models to estimate lives saved by racial/ethnic group. We are in the process of further developing our other models to provide these estimates for additional preventive services. 11 Prevention: A Key Indicator of Quality There is ample evidence to show that increasing use of proven preventive services will result in fewer people suffering from diseases that could have been prevented or treated with less pain at early stages. Also, preventive services are often more cost effective—meaning they provide better value for the dollar—than waiting to treat diseases, and some preventive services even save more money than they cost. Underuse of effective preventive care is a wasted opportunity. The U.S. health care system suffers a quality deficit in part because too many patients do not get the effective preventive care they need when they need it. How Cost-Effective is Evidence-Based Preventive Care? The NCPP’s analysis of the cost effectiveness of 25 recommended preventive services demonstrates that for a relatively small net cost, most of these services produce valuable health benefits. Eighteen of the 25 preventive services evaluated by the NCPP cost $50,000 or less per quality-adjusted life year (QALY) and 10 of these cost less than $15,000 per QALY, all well within the range of what is considered a favorable costeffectiveness ratio. (A QALY is a measure that accounts for both years of life gained and disease and injury avoided.5) Six preventive services—advising at-risk adults about regular aspirin use, counseling smokers to help them quit, immunizing children, screening/counseling adults about alcohol misuse, vision screening among older adults, and the pneumococcal immunization for older adults—all save more money than they cost. Measuring Cost Effectiveness Cost effectiveness (CE) measures economic value, or the cost of producing a unit of health, such as a quality-adjusted life year or QALY. A QALY is a measure that accounts for both mortality (years of life lost) and morbidity (quality of life lost due to days lived with sickness). CE = $s spent - $s saved QALYs saved The fewer dollars spent per QALY, the more cost effective the service. If the dollars saved are greater than the dollars spent, the service is cost saving. By itself, a service’s CE ratio does not indicate whether or not the service is cost effective because there is no specific figure that separates services that are sufficiently cost effective from those that are not. CE ratios must be compared to one another to see which services require the fewest dollars to produce the same unit of health. However, as a general rule of thumb, health care services are considered “cost effective” at less than $50,000 per QALY. 5 A quality-adjusted life year (QALY) is a year of life adjusted for its quality. Saving one QALY through prevention is equivalent to extending a life for 1 year in perfect health. 12 The bottom line: A health care system that optimizes use of high-impact, cost-effective preventive services is using its resources efficiently. Low utilization of these high-value preventive services squanders the chance to prevent pain and suffering for fewer dollars compared to waiting to treat diseases after they occur. Most Cost-Effective Preventive Services* Cost Saving Advising at-risk adults to consider taking aspirin daily Childhood immunizations Pneumococcal immunization (adults 65+) Smoking cessation advice and help to quit Screening adults for alcohol misuse and brief counseling Vision screening (adults 65+) $0 to $15,000/QALY Chlamydia screening (sexually active adolescents and young women) Colorectal cancer screening (adults 50+) Influenza immunization (adults 50+) Pneumococcal immunization (adults 65+) Vision screening in preschool age children $15,000 to $50,000/QALY Breast cancer screening (women 40+) Cervical cancer screening (all women) Cholesterol screening (men 35+ and women 45+) Counseling women of childbearing age to take folic acid supplements Counseling women to use calcium supplements Injury prevention counseling for parents of young children Hypertension screening (all adults) *Most cost-effective preventive services among the 25 preventive services recommended by the USPSTF and ACIP that were evaluated by the National Commission on Prevention Priorities. Source: Maciosek MV, Coffield AB, Edwards NM, Goodman MJ, Flottemesch TJ, Solberg LI. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med 2006; 31(1):52-61. 13 Why Don’t More People Receive the Preventive Services They Need? Although the reasons are complex, the following are important factors: `` Many health care providers lack systems or fail to use systems to 1) track their patients to determine who needs preventive services, 2) contact those patients to remind them to get the services, 3) remind themselves to deliver preventive services when they see their patients, 4) ensure the services are delivered correctly and that appropriate referrals and follow-up occur, and 5) make certain that patients understand what they need to do. `` The U.S. health care system benefits specialty care and acute care treatment at the expense of primary care and prevention, as evidenced by limited investment in developing a prevention-oriented health care workforce and limited training for doctors and other health care providers in delivering preventive care, in particular, how to deliver effective brief counseling messages to change behavior and improve compliance with prescribed medications that prevent disease and death. `` Demand for preventive services among consumers is weakened by high out-of-pocket costs for preventive services faced by the uninsured and those who have high-deductible insurance plans without exceptions for preventive care. Approximately 46 million Americans have no health insurance coverage at all. Two-thirds of the uninsured are either poor or near-poor, and minorities are more likely to be uninsured than white Americans.6 `` Many Americans, particularly minorities, have no connection to a regular source of health care with providers that will help ensure they are getting all the preventive services they need. In a 2006 survey, only 27 percent of Americans ages 18 to 64 reported having a regular doctor or source of health care and a medical home.7 Three-fourths of whites, African Americans, and Hispanics with medical homes reported getting the health care they need when they need it compared to 38 percent of adults without any regular source of health care.8 `` People are often unaware of the preventive services that are recommended for individuals of their age, gender, and risk factors, do not consider themselves to be at-risk, or are uncertain about the effectiveness of certain preventive services. Behavior change is also very challenging. Many people have great difficulty increasing and maintaining their exercise levels, changing and maintaining their diets, and permanently quitting smoking. Some preventive services, such as colorectal cancer screening, can be difficult to prepare for and are time-consuming. 6 The Kaiser Commission on Medicaid and the Uninsured. The Uninsured: A Primer. October 2006. http://kff.org/uninsured/7451.cfm. 7 A medical home was defined as a health care setting that provides timely, well-organized care with providers who are easy to contact. Beal AC and Doty MM. Closing the Divide: How Medical Homes Promote Equity in Health Care: Results From The Commonwealth Fund 2006 Health Care Quality Survey. The Commonwealth Fund, June 2007. 8 14 Use of High-Value Preventive Care and Lives Saved If Use Improved This chapter documents the use of preventive care among the general U.S. population for 12 of the 25 clinical preventive services included in the National Commission on Prevention Priorities’ rankings of preventive services. These 12 services are the only ones among the 25 that have utilization data available.9, 10 Data on use of these services among racial and ethnic groups are presented in the following chapter of this report. All 12 services fall into the top-half of the NCPP’s rankings. This chapter also quantifies the health impact, in most cases the lives saved, if utilization among all people eligible for the service were increased from current levels to 90 percent. Discuss Daily Aspirin Use The U.S. Preventive Services Task Force (USPSTF) recommends that health care providers discuss the benefits and potential harms of regular use of low-dose aspirin with men age 40 and older, postmenopausal women, and younger people with risk factors for coron