State Mandates for Preventive Health Services

To the Editor: Dr Nelson and colleagues¹ found that the rates of safety belt use, mammography, and adult vaccinations increased in most states in the 1990s, while the rates for other important health risk factors and clinical preventive services varied or worsened. The authors note that state mandates for insurance coverage of mammograms were one likely contributor to the increase in the rates of mammography. Although state mandates may play a role in increasing the delivery of other clinical preventive services, preliminary data demonstrate that state mandates currently apply to an inconsistent array of preventive services.² State mandates are most common for mammography, but few states mandate coverage of counseling and behavioral interventions to address unhealthy behaviors such as tobacco use, alcohol use, and other risk factors. More states (n=27) mandate coverage of prostate cancer screening than colorectal cancer screening (n=17), despite the fact that much stronger evidence exists for the benefits of screening for colorectal cancer.