Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

PART IV
PREVENTION AND RISK

Part IV assesses prevention and risk within health insurance. Both concerns impact on health financing and ultimate access. If the goals of prevention can help limit costs, then more attention must be paid. Yet costs saved in this area will be squandered unless there are accompanying reductions in the cost of mounting risk.

In Chapter 11 Saint-Germain and Longman examine preventive health. Even when breast self-examination training was provided free (particularly among older, widowed women with less education and income and with poorer general health) there was a general refusal to participate. While a dollar spent in prevention may generate much more dramatic outcomes and benefits than a dollar spent in primary care, the social stereotypes that undervalue older women limit their willingness to take preventive action.

In looking specifically at Hispanic women, Saint-Germain and Longman note that Hispanics are more likely to receive late-stage diagnosis, with its accompanying poorer success rate, because of irregular screening and the failure to respond to symptoms. Their study examines 400 Hispanic women in Arizona to determine reasons for noncompliance. The importance of social tradition and family structure is highlighted here, and the authors conclude that any activities geared at challenging traditional social norms must recognize limits. Since earlier detection could reduce mortality by 30 percent, the authors stress the need for more research on cultural variations in responding to breast cancer.

Miller in Chapter 12 examines the costs contributing to increased medical charges from high medical malpractice premiums that have affected health

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