The medical director of a large health insurer, 100,000 enrollees with premium income of $500,000,000...

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The medical director of a large health insurer, 100,000 enrollees with premium income of $500,000,000 has a preventive care budget of $10,000,000 (2% of total premium income). Given the list of preventive care services (ranked in declining order of cost effectiveness below and located in the Problem 9.1 tab in the BudgetCh09.xls file), their prices, and the number of eligible members who could benefit from each service (assume only 40% of eligible will partake of preventive care offerings), what services should be offered or where should the medical director draw the line?

Effect-

# of

iveness

Program

Price

Patients

1

Daily Aspirin Use, discussion

$20

10,000

2

Smoking cessation, discussion

$30

23,000

3

Colorectal cancer screening

$18

40,000

4

Hypertension screening

$50

40,000

5

Influenza immunization

$5

22,000

6

Problem drinking screening & counseling

$30

8,000

7

Vision screening

$50

100,000

8

Cervical cancer screening

$125

25,000

9

Breast cancer screening

$100

25,000

10

Chlamydia screening

$58

14,000

11

Calcium supplements, discussion

$20

50,000

12

Folic acid supplements

$20

50,000

13

Obesity screening and counseling

$50

33,000

14

Depression screening

$50

24,000

15

Hearing screening

$150

50,000

16

Injury prevention counseling (0-4)

$50

1,600

17

Osteoporosis screening

$225

23,000

18

Cholesterol screening-high risk

$53

60,000

19

Diabetes screening

$63

7,000

Source:

Priorities Among Effective Clinical Preventive Services, Results of a

Systematic Review and Analysis, Maciosek MV, Coffield AB,

Edwards, NM, Flottemesch, TJ, Goodman, MJ, and Solberg LI,

Am J Prev Med, 2006; 31(1), 52-61.

If your solution does not use all available funds, develop alternatives that will. How many preventative services can be delivered to members?

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