Often the United States health care system is considered treatment for the sick or simply diagnosis and treatment, but it should also prevent patients from getting sick.  It is evidenced based best practice to work toward a health system with a strong focus on preventative health care so that we can move toward a healthier population and reduce health problems in the future. 

The Affordable Care Act (ACA) covers certain health promotion services, but unfortunately not all and some services are only partially covered.  Health preventative services that are not covered or only partially covered may create a financial challenge or barrier for the patient.  For example, ACA covers some preventative birth control and other medications, but it does not cover brand name (Preventive Services Covered by Private Health Plans under the Affordable Care Act, 2015). 

Opportunities that are related to the integration of the ACA includes the ability to offer patients preventative health screening and services at no cost or low cost to them.  This is important because it can help patients who would not normally participate in preventative health measures possibly due to social determinants of Healthcare, to start participating in preventative health services and thus prevent future health issues (Daniel, Bornstein, & Kane, 2018).   Another opportunity is with the increased mental health issues in our population, the ACA covers many preventative mental health screening and treatment. The ACA also provides the opportunity to expand the knowledge and quality of preventative health services in the community.

About 50% of American adults suffer from at least one chronic condition and government programs like the ACA support research and other federally sponsored programs that can benefit this large part of the population (Leppin, A.L., Schaepe, K., Egginton, J. et al, 2018).

Challenges related to the ACA and preventative health services include billing issues that may cause charges to the patient, including if the reason for the visit is not preventative or if the office visit and preventative service are billed separately (Preventive Services Covered by Private Health Plans under the Affordable Care Act, 2015).  Another potential issue that can cause additional costs is if out-of network providers are used, when in network providers are available plus finding and waiting for an appointment at an in network provider could cause delays in care (Preventive Services Covered by Private Health Plans under the Affordable Care Act, 2015).

References

Daniel, H., Bornstein, S., & Kane, G. (2018). Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Retrieved from ACP: https://annals.org/aim/fullarticle/2678505/addressing-social-determinants-improve-patient-care-promote-health-equity-american

Leppin, A.L., Schaepe, K., Egginton, J. et al. Integrating community-based health promotion programs and primary care: a mixed methods analysis of feasibility. BMC Health Serv Res 18, 72 (2018) doi:10.1186/s12913-018-2866-7

Preventive Services Covered by Private Health Plans under the Affordable Care Act. (2015). Retrieved from KFF.org: Preventive Services Covered by Private Health Plans under the Affordable Care Act