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"The annual physical is a waste of time," insists Donald B. Louria, MD, chairman emeritus of the Department of Preventive Medicine at the University of Medicine and Dentistry of New Jersey. "It makes money for the laboratories, but it does nothing for public health."
Yet Louria is the moving force behind a New Jersey law that requires every health insurance plan in the stateHMO, PPO or indemnityto offer every enrollee over 19 an annual health checkup. The most stripped-down small business plans are exempt, as are self-insured employers, but Louria is betting the latter will soon bow to consumer demand and add the benefit.
What's going on here? Louria is slamming the old-style annual checkupheavy on imaging and testingand advocating a new emphasis on wellness advice and personal consultation. He actually persuaded the state legislature to mandate such an annual physical in 1993, but in the subsequent regulatory process some insurers got permission to offer the exam as an extra-cost rider. That killed the whole idea. The revised law that went into effect in November closes that loophole, but it also sets a limit of $220 on what the mandatory exam can cost the plans. The cap will be adjusted automatically for inflation, and the design of the exam will change over time.
The state spells out the minimum, including basic blood tests for hemoglobin, glucose and cholesterol levels plus height, weight and blood pressure measurement and a breast exam for women. More involved tests, such as those for glaucoma and colon cancer, are mandated every five years for older patients.
But the heart of the session is a 15 to 20 minute healthy living conference that by law must touch on designated subjectsseat belt use, stopping smoking, weight control, self-exams for breast or testicular cancerand leave time for the patient to select other topics from a list. That might be what to expect from menopause or how to advise children about sexually transmitted disease, but probably will not be the kind of symptomatic health problem that would regularly bring a patient to the doctor.
With this kind of directed checkup, "for every dollar you spend, you save two dollars," Louria claims. New Jersey is alone in imposing such a mandate, but Louria says that he has been hearing from lawmakers and insurance regulators in other states. He thinks other jurisdictions will follow the Garden State, especially if follow-up studies show that the predicted savings are real.
Daniel Moskowitz. New Jersey mandates annual physicals with a twist. Business and Health 2001;1:25.