The study, for the first time, explored the utilization of an evidence-based package of all recommended preventive services in a publicly financed healthcare system. Our findings suggest that there are significant gaps in the receipt of high-priority preventive interventions. The results are consistent with findings from previous studies that evaluated the uptake of individual preventive services 1,2,4. We have found that the receipt of preventive screening was highest in older adults aged 70 or more. The finding may be linked with the fact that the elderly are more likely to receive clinical care and medical advice, both in hospital as well as a primary care setting 5,6. The uptake of cancer screening services, such as colonoscopy and PSA testing, was surprisingly low, at 15.2% and 26.2%, respectively. We have found significant gaps even among the highly-utilized services such as GP visits, blood pressure screening, cervical smear, and blood glucose screening, where nearly a third of the population had not received preventive care.
Preventive counselling, which ranks among the top cost-saving interventions7, is delivered to less than a quarter of the population. The result highlights a wide gap in the delivery of these impactful interventions. The projections show that higher uptake of preventive counselling for tobacco cessation, alcohol misuse, depression, and obesity would add over 1 000 000 QALYs and save billions of dollars 7,8.
The differences in the receipt of preventive services among men and women were significant. Females were significantly more likely to receive laboratory tests (blood glucose, lipid profile) and colon cancer screening. These results are consistent with previous findings, which indicate that women have higher medical care service utilization than men 3,9.
Overall, almost 75% of all adults expect the public health system to provide them with all recommended preventive services. The metric shows a high interest among individuals in preventive care. Moreover, in our study, the respondents were willing to employ telemedicine solutions to access preventive care remotely. These results may indicate that a higher utilization rate could be achieved by improving health communication and using new channels of service delivery.
The study is subject to limitations. First, receipt of preventive services was self-reported and may be subject to recall bias. Self-report data tend to overreport utilization rates 10. However, in our study, rates of service use were consistent with estimates from European data 4. Secondly, while the results are nationally representative, the sample size did not facilitate more analyses of disparities in receipt of preventive services. Thirdly, to select a representative sample of the Polish adult population, a stratified sampling per the demographic structure of voivodeships was used. However, we set target quotas for age and sex strata in each geographical region. Therefore, the inherent limitations of quota-sampling are present.
Projections of future morbidity and burden of disease indicate that chronic illness will continue to be the most significant contributor to mortality and disability in Europe and high-income countries 11. It is estimated that almost nine out of ten deaths in the European Union are due to chronic diseases, including cancer, cardiovascular disease, diabetes, and mental illness12. The financial load linked with the management of chronic diseases is enormously high, and given that the burden of chronic diseases is continuously increasing, chronic illness will continue to put heavy pressure on national economies. Today, more than 50 million people in Europe have multiple chronic conditions, which incur even higher costs of care and treatment13. Clinical preventive strategies are available for many chronic diseases and their value, both health impact and cost-effectiveness remain consistent 7. Projections show that investment in a high-priority evidence-based package of preventive interventions for the population would produce over two million additional years of life each year they are provisioned 8. For example, preventive counselling for tobacco use, alcohol abuse, and depression, which proved to be significantly underutilized in our study, are an expected cost-saving service 7. Increasing the receipt of evidence-based preventive services results in a reduction of complications of the illness, long-term healthcare costs, and premature deaths.
Despite the mounting evidence, the uptake of preventive services is surprisingly low. The primary reason includes a low level of public awareness about high-priority preventive services, gaps in provider capacity, including long waiting times, and higher focus on diagnosis and provision of treatments rather than preventive interventions among healthcare providers 2. A recent study has shown that both medical personnel and administrative stakeholders are aware of the health and economic benefits of disease prevention 14. It is assumed that the low uptake of the preventive services is due to an implementation gap, which is caused by a lack of financial incentives for medical providers to prevent chronic illness. To date, the majority of providers, in particular hospitals and medical professionals, are paid to manage rather than to prevent disease.
In conclusion, despite the current limitations, comprehensive preventive care is attainable. Our data indicate that almost a third of adults reported utilizing more than half of the recommended preventive interventions, and only 0.7% had not received preventive care at all (Appendix C). Services that are most commonly not being delivered, such as preventive counselling, need to be emphasized to achieve greater coverage of the population. Further improvements require not only changes in the incentive system for healthcare providers, but also system-level innovation such as telemedicine solutions to deliver preventive services remotely and engage individuals in the monitoring process. A systemic and rational approach to ensuring that all individuals receive evidence-based preventive services is urgently needed. The effective preventive strategy will attain the multiple objectives of improving the quality of life, extending the human lifespan, and making the best use of scarce resources.