Requiring Women To Undergo Unnecessary Annual Exams For Birth Control Highlights Costs Of Overtreatment

Unnecessary health costs add some $158 billion to the nation’s health care tab, and requiring women to undergo pelvic exams before receiving a prescription for birth control pills only adds to this total. As Mother Jones’ Stephanie Mencimer explains, despite any evidence showing that the annual exam improves health outcomes, one-third of doctors always require women to undergo a Pap smear before they prescribe hormonal contraception, and 44 percent regularly do so:

For instance, there’s no evidence that doctors can diagnose ovarian cancer with a pelvic exam in women showing no symptoms. A clinical trial found that doctors were unable to identify any cancers in test subjects by pelvic exams alone, and the National Cancer Institute no longer recommends the tests for postmenopausal women. […] The scientific basis for much of the traditional well-woman ob-gyn annual check-up is so slim that “the routine pelvic examination may be an example of more service leading to worse outcomes,” Dr. Carolyn Westhoff, an ob-gyn at Columbia University, wrote in the Journal of Women’s Health last year.

So why are doctors so adamant about the additional testing? Drug and medical device companies fund most continuing medical education, which is primarily how doctors learn about new science, and these industries are not interested in limiting care, Shannon Brownlee, a health policy expert at the New America Foundation, explains to Menicmer. Under the existing fee-for-service health reimbursement system, doctors are also paid for every additional procedure — regardless of whether it actually improves patient care.

Delinking pelvic exams from women’s birth control prescriptions underscores the importance of health research in guiding health care decisions. The Affordable Care Act invests in comparative effectiveness research to help determine the most cost-effective course of treatment, and it also begins to recalibrate the system so we stop paying doctors for unnecessary care and instead reimburse them for treatments that only bolster patient outcomes.