Ask Dr. Jon Hallberg: How effective are general health checks?

ST. PAUL, Minn. — General health checks are included in the Affordable Care Act and they are now covered in a variety of health care plans. A recent article in the Journal of the American Medical Association raised a question about how effective they are.

Steven John of All Things Considered spoke about wellness checks with Dr. Jon Hallberg, a family medicine physician at the University of Minnesota. An edited transcript of that conversation follows.

STEVEN JOHN: Let’s start with the definition of a general health check.

JON HALLBERG: There are so many different terms that mean the same thing. Wellness visit. Check-up. Physical exam. For the purposes of this article they mean a visit where the primary and only purpose is to come in and look for things you could prevent, to screen for diseases you may not know are present.

JOHN: Why is JAMA looking at this issue now?

HALLBERG: It’s a very good time to be doing this because Medicare now has a "welcome to Medicare physical exam" that is covered. With the ACA, people are able to go in for a wellness visit once a year without a co-payment. Many people feel it’s a very important cornerstone to primary care.

JOHN: What did this article point out?

HALLBERG: It’s reviewing many previous studies. They looked at about 16 eligible studies that were rather massive. They narrowed it down to nine that really looked at this question of, if a person has a wellness visit as opposed to what they call "usual care," does that actually make a difference? Does it save lives?

When they looked at 150,000 people, the answer was not clear and in fact, it did not seem to show any kind of a difference.

JOHN: At first blush it looks like these studies are saying that wellness visits do very little to reduce mortality.

HALLBERG: Right. It didn’t really look at whether they reduce morbidity, which is illness overall. I think it’s really important we look at when the studies were done. Most of them were done starting before 1975. A lot has changed in a quarter of a century. Once we delve into it a little bit we realize there are some significant limitations to the findings.

JOHN: How common is the pure wellness visit?

HALLBERG: If a person were to come to the clinic and truly have no complaints, no agenda, that simply they are well and coming in for a visit simply because they’re told to come in — these are adults we are talking about — I would say almost never.

JOHN: Are wellness visits or general health checks are a good thing overall?

HALLBERG: They are for a couple of reasons. When people come in for a wellness visit is a chance to reinforce the relationship. I have to believe that that is good in the long run.

We have to be careful about how many conclusions we draw from it because it really was old. We have newer drugs now. We didn’t have statin medications for cholesterol. We didn’t define diabetes the same way we define it now. We weren’t treating depression because we didn’t really have medications like we have now, at least on a large scale. We now need to craft some studies for the 21st century, the way health care now is delivered.

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