But they have not been uniform in emphasizing what they consider to be appropriate preventive measures. In addition to the hassle of regular record audits, Dr. Baluta worries that the reviews will not accurately reflect the preventive care he has provided, a fear that experts say may be justified. For physicians like Drs. Shagan and Baluta, health plans' motivation is suspect. If they were truly interested in keeping their patients healthy, these doctors maintain, the plans would pay physicians for their time to provide such services.
Health plans counter that physicians are already paid for such services.
He added that federal government data show patients typically visit the doctor's office about three times a year, allowing opportunity for periodic follow-up. But physicians see another reason for health plans' reluctance to pay for education and counseling. Critics say that the reluctance of many health plans to pay for prevention ends up costing patients as well as physicians. Instead, some plans do just a little, like send prevention-oriented mailings to their members. United HealthCare, for example, has sent notes to women over age 50 to remind them to get a mammogram, and Kaiser Permanente provides members with self-care books.