Federal Medicare benefits were recently expanded to include an introductory physical aimed at screening patients at age 65 for problems such as alcoholism, depression, high blood pressure, and diabetes.

Backed by a national outreach campaign, officials hope the screenings will help doctors ID and treat undetected health problems and save the Medicare program money in the long run.

"The initial physical is intended to make Medicare into a prevention-oriented program," said Medicare Administrator Mark B. McClellan. The American Medical Association says that alcohol abuse is a "hidden epidemic" among the elderly, estimating that 3 million seniors have drinking problems, for instance.

The biggest hurdle for the screening program may be participation, however. "Prevention-oriented medicine is not the way Medicare has worked in the past," McClellan said. "What we need to do now is close the gap in prevention as a result of people not taking advantage of all the new benefits. This is about the biggest deal we are undertaking."

Medicare officials would like doctors ask patients about falls and look for signs of dementia, as well as other signs of alcohol misuse, during the initial physical. But with doctors getting paid less than $100 to do the checkups, experts worry that the encounters with patients won't be detailed enough to spot signs of substance abuse. A lack of follow-up care also could present problems.

"There are two pieces to the puzzle," said James Firman of the National Council on the Aging. "One is providing the coverage. The other is getting people to act on it. Prevention is an uphill battle."

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