This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above.1,2 It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop.

As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicare—or to society generally—is not evaluated for the services examined.

The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000–2004.

In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions.


Skin Cancer Screening

The three major kinds of skin cancers are melanoma, basal cell carcinoma, and squamous cell carcinoma. The latter two are often grouped together as nonmelanoma skin cancers. Melanoma accounts for less than 5 percent of reported cases of skin cancer but about 80 percent of deaths. Squamous cell carcinoma accounts for most of the rest.


For the other services, see Extending Medicare Reimbursement in Clinical Trials and The Role of Nutrition Therapy in Maintaining the Health of the Nation’s Elderly: Evaluating Coverage of Nutrition Services for Medicare Beneficiaries, both available from the National Academy Press (


As this report was being completed, Congress extended coverage of immunosuppressive drugs for up to eight months (subject to expenditure limits) for transplant recipients eligible for Medicare by reason of age or disability (P.L. 106–113).

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