Delivering prevention: The role of public programs in delivering care to high-risk populations

A successful program of prevention or early detection should have a high le vel of population coverage and should ensure that high-risk populations are targeted. In practice, relatively little attention has been paid to the te ndency toward greater use of preventive care by populations at lower risk, in other words, for higher use by the wealthy than by the poor. Current del ivery patterns of preventive care raise questions as to how to organize the se services more effectively. physician-based delivery of preventive care i n a fee-for-service system seems to result in Canadian patterns of use that are fairly similar to those found in the United States. Universal free ins urance alone does not appear-to be enough to Counteract the failure to targ et preventive care toward the least-healthy groups. Appropriately-run Canad ian provincial programs may be able both to expand coverage and to target h igh-risk populations. The population coverage for three measures directed t oward prevention or early detection-childhood immunization (which in Manito ba has been offered through along-standing provincial program), screening m ammography (a new provincial program), and cervical cancer screening (no pr ovincial program)-are compared using longitudinal administrative data from Manitoba. The discussion emphasizes the role of provincial programs and the possibilities for: using population-based data to help provide cost-effect ive care to high-risk populations.