Blue Cross offers to cover routine tests Many say package heralds new focus on preventive care

June 19, 1991|By Robert Pear | Robert Pear,New York Times News Service

WASHINGTON -- In a departure from longstanding practice in the health insurance industry, which has emphasized the treatment and cure of disease without paying for much preventive care, Blue Cross and Blue Shield offered yesterday to provide insurance for routine tests to detect cancer, heart disease and other illnesses.

The Blue Cross and Blue Shield Association issued guidelines for a lifetime schedule of medical tests to detect adult diseases and said it would offer coverage for these services.

Other private insurers have expressed a willingness to cover preventive services and are expected to use the guidelines.

"We believe this will set the standard for the health insurance industry to give millions of Americans peace of mind and healthier lives," said Bernard Tresnowski, president of the Blue Cross and Blue Shield Association.

The new coverage is envisioned as an expansion of existing policies.Blue Cross said it could cover the costs of insurance for preventive and screening services by charging additional premiums of about $90 a year for a family and $36 a year for an individual.

The guidelines come in response to a nationwide consensus of health policy experts that insurers should cover more preventive services.

That idea is backed by both the Public Health Service and the American College of Physicians, the nation's largest medical specialty organization, which will distribute the guidelines to its 70,000 members.

The college developed the guidelines over several years in cooperation with the Blue Cross and Blue Shield system, which is the nation's largest private health insurer, covering 73 million Americans.

Health economists suggested that Blue Cross was also motivated by a sense of enlightened self-interest because there appears to be a growing demand among employers and consumers for insurance to cover screening and preventive care, including health education and counseling to stop smoking.

The screening package specifies who should be tested and when tests should be taken for high blood pressure, heart disease, cholesterol, diabetes, thyroid problems, osteoporosis and cancers of the breast, colon, cervix and lung.

Equally important, the guidelines say certain techniques are not recommended as routine screening procedures for people with no symptoms.

Dr. Paul F. Griner, chairman of the board of regents of the American College of Physicians, said that screening -- the search for specific health problems in a person who has no known signs or symptoms -- "has enormous medical value in finding disease early, when it can be treated most successfully and most economically."

Pam Kelch, a spokeswoman for Blue Cross and Blue Shield, said that the medical tests included in the new benefits package would not be used to screen out people found to have costly diseases or a high risk of developing such illneses.

Mr. Tresnowski said that the group's 73 local plans around the country could offer coverage of the recommended screening tests for "a nominal amount," about $7.50 a month for a family whose insurance coverage now typically costs $200 to $300 a month.

Dr. David M. Eddy, professor of health policy management at Duke University, who edited the guidelines, estimated that national spending on health care would increase by $2 billion to $3 billion a year if all adults complied with the screening recommendations.

But Dr. Griner said that the extra spending would result in "improved productivity of employees, greater longevity and improved quality of life" for millions of people. The United States spends more than $660 billion a year on health care, and the amount has doubled in the last eight years.

The 73 independent non-profit Blue Cross and Blue Shield plans will be strongly encouraged but not required to offer the additional coverage. They operate 89 health maintenance organizations providing care for 4.6 million people.

Blue Cross and Blue Shield anticipate that within a year, 60 percent of its subscribers will be covered by the package of screening benefits, Mr. Tresnowski said.

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