Intended for healthcare professionals

Bmj Usa

The “Welcome to Medicare” visit: a chance to raise the profile of prevention among older adults

BMJ 2005; 330 doi: (Published 11 February 2005) Cite this as: BMJ 2005;330:E337
  1. Steven H Woolf, professor of family medicine, preventive medicine and community health (,
  2. Ashley B Coffield, senior policy fellow
  1. Virginia Commonwealth University Fairfax, Virginia
  2. Partnership for Prevention Washington, DC

Americans receive only half of recommended clinical preventive services—screening tests, counseling about health behaviors, immunizations—due to deficiencies in the delivery system that extend to therapeutic services as well.1 Gaps in preventive care are a special concern, however, because of their importance in maintaining the health of the population and in stemming the rising incidence and costs of chronic diseases.

The failure of older adults to receive preventive services is exacerbated by special issues. Many seniors live with the misconception that it is too late to benefit from stopping smoking or physical activity, although science suggests otherwise.2,3 A longstanding impediment has been lack of coverage of preventive services under the Medicare program. The legislation that created Medicare in 1964 authorized coverage only of diagnostic and treatment services, making it necessary for Congress to pass individual laws to provide coverage for Pap smears and other preventive services.4

A string of such bills, enacted between 1980 and 2003, has now expanded Medicare coverage to include screening for breast cancer, colorectal cancer, cervical cancer, prostate cancer, osteoporosis, hyperlipidemia, diabetes, and glaucoma, as well as pneumococcal, influenza, and hepatitis B immunizations. But problems persist. For example, some preventive services …

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