Report at a Glance
Clinical Preventive Services for Women: Closing the Gaps
As a centerpiece of the Patient Protection and Affordable Care Act (ACA) of 2010, the focus on preventive services is a profound shift from a reactive system that primarily responds to acute problems and urgent needs to one that helps foster optimal health and well-being. Women stand to benefit from this shift given their longer life expectancies, reproductive and genderspecific conditions, and historically greater burden of chronic disease and disability. And, for the same reasons, they will benefit economically since the ACA removes cost-sharing requirements for specified preventive services— eliminating out-of-pocket costs that often put screenings, counseling and procedures supporting health out of reach for moderate- and lower-income women.
Given the magnitude of change, the U.S. Department of Health and Human Services (HHS) charged the Institute of Medicine (IOM) with reviewing what preventive services are important to women’s health and well-being and then recommending which of these should be considered in the development of comprehensive guidelines. The IOM convened a committee of experts to identify critical gaps in the preventive services already identified in the ACA, which are based on recommendations developed by three independent bodies: the United States Preventive Services Task Force, the American Academy of Pediatrics’ Bright Futures recommendations for adolescents, and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
The committee defined preventive health services as measures— including medications, procedures, devices, tests, education, and counseling— shown to improve well-being and/or decrease the likelihood or delay the onset of a targeted disease or condition. To guide its deliberations in determining gaps in preventive services not included in existing guidelines, the committee developed four overarching questions:
- Are high-quality systematic evidence reviews available which indicate that the service is effective in women?
- Are quality peer-reviewed studies available that demonstrate effectiveness of the service in women?
- Has the measure been identified as a federal priority to address in women’s preventive services?
- Are there existing federal, state, or international practices, professional guidelines, or federal reimbursement policies that support the use of the measure?
Preventive measures recommended by the IOM committee for preventive coverage consideration met the following criteria:
- The condition to be prevented affects a broad population;
- The condition to be prevented has a large potential impact on health and well-being; and
- The quality and strength of the evidence is supportive.
The committee took seriously its task of focusing on women’s unique health needs. Throughout the study process, the committee repeatedly questioned whether the disease or condition was significant to women and, especially, whether it was more common or more serious in women than in men or whether women experienced different outcomes or benefited from different interventions than men.