WASHINGTON — Problem drinking among the elderly may cost Medicare more than $230 million a year to treat liver disease and other ailments, but only now will the huge healthcare program start covering routine screening for alcoholism.
Beginning this week, newly enrolled Medicare beneficiaries are eligible for an introductory physical that emphasizes prevention of conditions including alcoholism, depression, high blood pressure and diabetes.
The initial checkup after turning 65 is part of a broader effort to improve how doctors care for the elderly before Medicare is overwhelmed by the costs of the baby boomers. This year, Medicare begins covering preventive tests for diabetes and high cholesterol. And it is planning a national outreach campaign to emphasize prevention.
"The initial physical is intended to make Medicare into a prevention-oriented program," said Medicare Administrator Mark B. McClellan.
Alcohol counseling may sound as if it belongs in a health plan for twentysomethings, not grandparents. But in fact, Medicare is behind the times. It has been nine years since the American Medical Assn. warned of a "hidden epidemic" of alcoholism among the elderly, estimating that about 3 million have drinking problems, and that many go undiagnosed.
Medicare's omission of early alcohol screening is a part of a weak overall record on preventive care. For most of its history, the program excluded coverage of routine checkups. In the 1980s and 1990s, it began to cover some preventive services, such as flu shots, Pap smears and colon cancer screening.
This year, it finally begins to provide a range of services that resembles those available through employer-sponsored health plans.
Yet the congressional Government Accountability Office reported in the fall that few elderly beneficiaries were getting all the preventive care they were entitled to. For example, although 91% of women covered by Medicare received at least one preventive service, only 10% were screened for cervical, breast and colon cancer and also got flu and pneumonia immunizations.
"Prevention-oriented medicine is not the way Medicare has worked in the past," McClellan acknowledged. "What we need to do now is close the gap in prevention as a result of people not taking advantage of all the new benefits. This is about the biggest deal we are undertaking."
Dealing with problem drinking may be one of the toughest preventive challenges.
