Half of all American women have skipped health visits, follow-ups or treatments because they couldn’t afford to pay, according to a 2011 report by the Commonwealth Fund. Women have also been paying higher health insurance premiums, with 92 percent of U.S. health plans practicing gender rating, according to a 2010 report from the National Women’s Law Center. The report added that 56 percent of plans charge non-smoking women more for coverage than male smokers.
All that should change as President Barack Obama’s reelection lowers the uncertainty about the Affordable Care Act and the new law continues its gradual implementation. The predictable effect will be a major expansion of women’s preventive health care. More in doubt, however, is which doctors will provide that care.
Currently, many healthy women with adequate health coverage have two primary care doctors, in contrast to men, who generally have one. Women see a primary care doctor and an obstetrician-gynecologist, a specialist who often requires a referral under current systems.
But that could change since the new health law defines certain services as primary or preventive care but leaves open the matter of who provides that care. It could be a general practitioner or internist or another primary-care provider. Or it could be the physician who does a woman’s annual Pap smear, while she’s in the office for a regular visit.
Beginning this year, all new plans have been required to cover preventive services — including cervical cancer screenings, mammograms and contraceptives, among many other services –without co-pays, coinsurance or cost sharing. Existing plans will phase that in over time. Medicaid expansion in most states and the mandate to buy health insurance will further expand coverage of women’s preventive care.
Many states already allow women direct (non-referral) access to specialists such as ob-gyns. The new law mandates this, so an increasing number of insured women means an increasing number of visits. Many ob-gyns already provide preventive services that are not specific to women, such as complete physical exams, blood pressure readings and blood cholesterol tests, says Dr. Albert Strunk, a deputy executive vice president for the American Congress of Obstetricians and Gynecologists, called ACOG.
Strunk argues that ob-gyns–who are in short supply in many parts of the country–should be included in the new law’s program for increasing Medicaid primary care reimbursement rates, another facet of the law designed to address primary care needs for both sexes.
Since ob-gyns see women as their regular practice, they will be more in tune with potential problems, such as fibroids, cancer or anything else out of the ordinary. If the health care provider is not an ob-gyn, it is essential that the person “have ongoing training and experience; not someone who just did some rotations,” Clark says. She applauds the Affordable Care Act for doing away with higher co-pays for ob-gyns because “gynecologists should not be treated as rare specialists.”
But Dr. Jeffrey Cain, chairman of the American Academy of Family Physicians, cautions against thinking that women can do away with their general practitioner. Cain, based in Denver, says women benefit from the family physician’s “broader perspective” and coordination of care. Studies have shown that when people have a “first contact” provider, no matter what type, their overall costs decline and their health improves, Cain said.
Cain expects ob-gyns to take an increasingly close place beside family doctors and other general practitioners as the system moves toward what he and others call “team-based care.”
Ms. readers, would you rather go to your primary care physician or your ob-gyn for preventive services? Answer in the comments box.