Another factor that was difficult for the committee to fully ignore was the cost implications of the recommended services on the insurance market. Costs and cost-effectiveness are not easy to define or measure and differ depending upon priority perspectives—private insurer, government payer, patient, or society. The 2009 IOM study Initial National Priorities for Comparative Effectiveness Research examines priorities for considering cost-effectiveness in developing policy decisions (IOM, 2009a). Although the cost-effectiveness of services and examination of what the impact of new preventive health care services will have on health insurers were specifically excluded from committee’s consideration, the committee notes that this sometimes made its task more difficult.

In addition, the committee deliberated on a number of interventions for reducing the incidence of diseases and conditions that were deemed effective but that were considered to be tertiary prevention, or interventions where a disease or condition had already been diagnosed. The committee determined that tertiary interventions involved treatment (and, potentially, prevention) decisions, which were outside of its scope.

Finally, questions rose as to what is common sense practice for a physician to discuss with patients. Does encouraging wearing a seat belt fall into this category? Is it the physician’s responsibility to counsel patients with no clinical risk factors about healthful eating? To what extent should adolescents be afforded confidentiality? The gaps in gender analysis made this task even more difficult.

The ACA offers much promise in promoting prevention as an effective tool to improve health and well-being. When patients have health insurance coverage, a clear understanding of recommended services and screenings, and a usual source of care, it is the committee’s belief that positive health outcomes will ensue. The ACA provides hope in efforts to eliminate health disparities and improve the health and well-being of women, children, and men across the United States.


AAP. 2008. Bright futures: Guidelines for health supervision of infants, children and adolescents, 3rd ed. (J. F. Hagan, J. S. Shaw, and P. M. Duncan, eds.). Elk Grove Village, IL: American Academy of Pediatrics.

IOM (Institute of Medicine). 2007. Preterm birth: Causes, consequences, and prevention. Washington, DC: The National Academies Press.

IOM. 2009a. Initial national priorities for comparative effectiveness research. Washington, DC: The National Academies Press.

IOM. 2009b. Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: The National Academies Press.

IOM. 2010. Women’s health research: Progress, pitfalls, and promise. Washington, DC: The National Academies Press.

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