A national women’s health survey conducted jointly by the Henry J. Kaiser Family Foundation and the Los Angeles Times reveals that a whopping 94% of women who visited their gynecologists within the last two years did not receive all of the tests and counseling recommended for them in national guidelines.
For example, while 94% percent received a Pap smear and 88% received a breast exam, only 42% received counseling on preventing bone loss, and only 35% of childbearing age received counseling on birth control. Less than 1/3 of the women studied received any testing or counseling about sexually transmitted diseases. Among women ages 40 to 64, only 66% discussed menopause and hormone replacement therapy.
More than half of the women surveyed said that they had spent 15 minutes or less with their doctor or provider during their last gynecological exam. Dr. Phillip G. Brooks noted that insurers are partly to blame for these short office visits. “Insurers no longer demand, no longer expect and no longer reward physicians for being comprehensive,” said Brooks. “The reimbursements today are such that if you are not efficient and fast, you can have trouble covering your overhead,” he explained.
Dr. James Heaps of the UCLA School of Medicine agrees. “For example,” said Heaps, “a woman may complain of pelvic pain. When we bill for that the insurance company says, ‘No, the patient came in for her “well-woman” (hypothetical name for exam including Pap smear and breast exam) visit.’ That’s $15 whether you spent 5 minutes or 50 minutes.”
A spokesperson for the American Assn. of Health Plans, Don White, disagrees that insurers are to blame. He contends that shorter doctor visits are due to poor patient-doctor communication and urges patients to “talk to their doctors about what they expect.”