Medicaid coverage no barrier to mammography access

NEW YORK (Reuters Health) - Women on Medicaid have a harder time scheduling a timely appointment for a diagnostic mammogram than women with Medicare coverage, new research shows.

But the difference is small, and can't explain why women with Medicaid insurance -- which covers poor and disabled people -- are less likely to get mammograms, more likely to be diagnosed with late-stage breast cancer, and more likely to die of the disease than women with Medicare or private insurance, according to the research team.

In contrast to screening mammography, diagnostic mammography evaluates women who have had an abnormal mammogram or have symptoms suggesting they're at high risk for breast cancer.

Dr. Jeremiah D. Schuur of Brigham and Women's Hospital in Boston and colleagues looked at diagnostic mammography to better understand whether being on Medicaid, in and of itself, could influence care. They also wanted to see if reimbursement rates play a role in access. The rates Medicaid pays for both diagnostic and screening mammograms vary significantly among states, and are almost always lower than what Medicare, the government program covering people 65 and older, will pay.

The researchers chose to investigate diagnostic mammography because its importance to women's health, and the need to be able to have the test in a given time frame, is clear.

One current guideline states that women should be able to have a diagnostic mammogram within 30 days after being told by a health care provider that they need one.

Schuur and his team had trained individuals working from a script call 521 mammography facilities in 11 states to request an appointment for a diagnostic mammogram and see if they could get an appointment within 20 business days. These "standardized patients" called each facility twice, once saying they had Medicaid, and once saying they had Medicare.

There was no relationship between a state's reimbursement rates and the likelihood that a woman would be offered an appointment or be able to schedule an exam in a timely fashion.

But while 99.1 percent of women who said they had Medicare were able to secure an appointment within 20 business days, 91 percent of women identifying themselves as being on Medicare were.

Whether this actually makes a difference to women's health is "an open question," Schuur told Reuters Health. But given that Medicaid patients still had a very good chance of getting a timely appointment, he and his colleagues say, having this type of insurance "is unlikely to be a substantial barrier to mammography."

"If the reimbursement rate was an important block to accessing mammography then it would be a relatively easy solution, but our research suggest that it's not that simple," Schuur said.

So improving diagnosis and treatment of breast cancer among women on Medicaid will require more complicated measures than just bumping up reimbursement rates, he added.

These might include "campaigns to raise awareness in underserved communities, patient and provider education, and outreach and case management with at-risk patients," he and his colleagues conclude.

SOURCE: Cancer, December 1, 2009.