FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 332:1138-1143 April 27, 1995 Number 17 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background On January 1, 1991, the Medicare program began offering reimbursement for screening mammography every two years. This study examined the use of mammography in women covered by Medicare during the first two years that the screening benefit was offered.

Methods Medicare bills for 1991 and 1992 from a nationally representative sample of 4110 women 65 years of age or older were examined to determine the degree of compliance with recognized guidelines for screening mammography and the extent to which the use of mammography was associated with having supplemental insurance, which shields patients from the out-of-pocket costs associated with using Medicare benefits.

Results A total of 36.9 percent of older U.S. women had mammography during the first two years of the Medicare benefit for screening mammography. Only 14.4 percent of the women lacking supplemental insurance had mammography, as compared with 44.7 percent of those with employer-sponsored supplemental insurance, 40.1 percent of those with self-purchased supplemental insurance, and 23.9 percent of those with Medicaid supplemental insurance. These differences persisted in the stratified and multivariate analyses. As compared with women lacking supplemental insurance, women with employment-based supplemental insurance were more likely to undergo mammography (adjusted odds ratio, 3.03; 95 percent confidence interval, 2.17 to 4.23), as were women with self-purchased supplemental insurance (adjusted odds ratio, 2.97; 95 percent confidence interval, 2.13 to 4.15) and women with Medicaid supplemental insurance (adjusted odds ratio, 1.99; 95 percent confidence interval, 1.30 to 3.07).

Conclusions The use of mammography was substantially below recommended levels during the first two years of Medicare coverage for screening mammography. Women lacking supplemental health insurance were at particularly high risk of failing to undergo mammography. Requiring copayments for preventive services is an obstacle to the effective mass screening of older women for breast cancer.

Source Information

From the Division of General Medicine, College of Physicians and Surgeons, and the Division of Health Policy and Management, School of Public Health, Columbia University, New York.

Address reprint requests to Dr. Blustein at the Division of General Medicine, PH9 East, College of Physicians and Surgeons, 630 W. 168th St., New York, NY 10032.

Full Text of this Article

This article has been cited by other articles:

• Schootman, M., Jeffe, D. B., Lian, M., Gillanders, W. E., Aft, R. (2009). The Role of Poverty Rate and Racial Distribution in the Geographic Clustering of Breast Cancer Survival Among Older Women: A Geographic and Multilevel Analysis. Am J Epidemiol 169: 554-561 [Abstract] [Full Text]  
• Wharam, J. F., Galbraith, A. A., Kleinman, K. P., Soumerai, S. B., Ross-Degnan, D., Landon, B. E. (2008). Cancer Screening before and after Switching to a High-Deductible Health Plan. ANN INTERN MED 148: 647-655 [Abstract] [Full Text]  
• Williams, B. A., Lindquist, K., Sudore, R. L., Covinsky, K. E., Walter, L. C. (2008). Screening Mammography in Older Women: Effect of Wealth and Prognosis. Arch Intern Med 168: 514-520 [Abstract] [Full Text]  
• Taylor, M. G. (2008). Timing, Accumulation, and the Black/White Disability Gap in Later Life: A Test of Weathering. Research on Aging 30: 226-250 [Abstract]  
• Trivedi, A. N., Rakowski, W., Ayanian, J. Z. (2008). Effect of Cost Sharing on Screening Mammography in Medicare Health Plans. NEJM 358: 375-383 [Abstract] [Full Text]  
• Wharam, J. F., Daniels, N. (2007). Toward Evidence-Based Policy Making and Standardized Assessment of Health Policy Reform. JAMA 298: 676-679 [Full Text]  
• Pham, H. H., Alexander, G. C., O'Malley, A. S. (2007). Physician Consideration of Patients' Out-of-Pocket Costs in Making Common Clinical Decisions. Arch Intern Med 167: 663-668 [Abstract] [Full Text]  
• Wharam, J. F., Landon, B. E., Galbraith, A. A., Kleinman, K. P., Soumerai, S. B., Ross-Degnan, D. (2007). Emergency Department Use and Subsequent Hospitalizations Among Members of a High-Deductible Health Plan. JAMA 297: 1093-1102 [Abstract] [Full Text]  
• Evans, K. D. (2007). Welcome to Ruth's World: An Autoethnography Concerning the Interview of an Elderly Woman. Qualitative Inquiry 13: 282-291 [Abstract]  
• Gross, C. P., Andersen, M. S., Krumholz, H. M., McAvay, G. J., Proctor, D., Tinetti, M. E. (2006). Relation Between Medicare Screening Reimbursement and Stage at Diagnosis for Older Patients With Colon Cancer. JAMA 296: 2815-2822 [Abstract] [Full Text]  
• Walter, L. C., Lindquist, K., O'Hare, A. M., Johansen, K. L. (2006). Targeting screening mammography according to life expectancy among women undergoing dialysis.. Arch Intern Med 166: 1203-1208 [Abstract] [Full Text]  
• Keating, N. L., Landrum, M. B., Guadagnoli, E., Winer, E. P., Ayanian, J. Z. (2006). Factors Related to Underuse of Surveillance Mammography Among Breast Cancer Survivors. JCO 24: 85-94 [Abstract] [Full Text]  
• Smith, R. A., Cokkinides, V., Eyre, H. J. (2006). American Cancer Society Guidelines for the Early Detection of Cancer, 2006. CA Cancer J Clin 56: 11-25 [Abstract] [Full Text]  
• Slater, J. S., Henly, G. A., Ha, C. N., Malone, M. E., Nyman, J. A., Diaz, S., McGovern, P. G. (2005). Effect of Direct Mail as a Population-Based Strategy to Increase Mammography Use among Low-Income Underinsured Women Ages 40 to 64 Years. Cancer Epidemiol. Biomarkers Prev. 14: 2346-2352 [Abstract] [Full Text]  
• Lee, T. H., Zapert, K. (2005). Do High-Deductible Health Plans Threaten Quality of Care?. NEJM 353: 1202-1204 [Full Text]  
• Smith, R. A., Cokkinides, V., Eyre, H. J. (2005). American Cancer Society Guidelines for the Early Detection of Cancer, 2005. CA Cancer J Clin 55: 31-44 [Abstract] [Full Text]  
• Rice, T., Matsuoka, K. Y. (2004). Book Review: The Impact of Cost-Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors. Med Care Res Rev 61: 415-452 [Abstract]  
• Consedine, N. S., Magai, C., Krivoshekova, Y. S., Ryzewicz, L., Neugut, A. I. (2004). Fear, Anxiety, Worry, and Breast Cancer Screening Behavior: A Critical Review. Cancer Epidemiol. Biomarkers Prev. 13: 501-510 [Abstract] [Full Text]  
• Mouchawar, J., Byers, T., Warren, M., Schluter, W. W. (2004). The Sensitivity of Medicare Billing Claims Data for Monitoring Mammography Use by Elderly Women. Med Care Res Rev 61: 116-127 [Abstract]  
• McWilliams, J. M., Zaslavsky, A. M., Meara, E., Ayanian, J. Z. (2003). Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults. JAMA 290: 757-764 [Abstract] [Full Text]  
• Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., Pinder, E. L. (2003). The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care. ANN INTERN MED 138: 273-287 [Abstract] [Full Text]  
• Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., Pinder, E t. L. (2003). The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care. ANN INTERN MED 138: 288-298 [Abstract] [Full Text]  
• Randolph, W. M., Goodwin, J. S., Mahnken, J. D., Freeman, J. L. (2002). Regular Mammography Use Is Associated with Elimination of Age-Related Disparities in Size and Stage of Breast Cancer at Diagnosis. ANN INTERN MED 137: 783-790 [Abstract] [Full Text]  
• Earp, J. A., Eng, E., O'Malley, M. S., Altpeter, M., Rauscher, G., Mayne, L., Mathews, H. F., Lynch, K. S., Qaqish, B. (2002). Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial. AJPH 92: 646-654 [Abstract] [Full Text]  
• Atherly, A. (2001). Supplemental Insurance: Medicare's Accidental Stepchild. Med Care Res Rev 58: 131-161 [Abstract]  
• Porell, F. W., Miltiades, H. B. (2001). Access to Care and Functional Status Change Among Aged Medicare Beneficiaries. Journals of Gerontology Series B: Psychological Sciences and Social Science 56: 69S-83 [Abstract] [Full Text]  
• Cummings, D. M., Whetstone, L., Shende, A., Weismiller, D. (2000). Predictors of Screening Mammography: Implications for Office Practice. Arch Fam Med 9: 870-875 [Abstract] [Full Text]  
• Redelmeier, D. A., Bell, C. M., Detsky, A. S., Pansegrau, G. K. (2000). Charges for Medical Care at Different Hospitals. Arch Intern Med 160: 1417-1422 [Abstract] [Full Text]  
• Yabroff, K. R., Mandelblatt, J. S. (1999). Interventions Targeted toward Patients to Increase Mammography Use. Cancer Epidemiol. Biomarkers Prev. 8: 749-757 [Abstract] [Full Text]  
• Roetzheim, R. G., Pal, N., Tennant, C., Voti, L., Ayanian, J. Z., Schwabe, A., Krischer, J. P. (1999). Effects of Health Insurance and Race on Early Detection of Cancer. JNCI J Natl Cancer Inst 91: 1409-1415 [Abstract] [Full Text]  
• Preston, J. A., Grady, J. N., Schulz, A. F., Petrillo, M. K., Scinto, J. D. (1998). The Impact of a Physician Intervention Program on Older Women's Mammography Use. Eval Health Prof 21: 502-513 [Abstract]  
• Earp, J. A. L., Viadro, C. I., Vincus, A. A., Altpeter, M., Flax, V., Mayne, L., Eng, E. (1997). Lay Health Advisors: A Strategy for Getting the Word out about Breast Cancer. Health Educ Behav 24: 432-451 [Abstract]  
• Selby, J. V. (1997). Cost Sharing in the Emergency Department -- Is It Safe? is It Needed?. NEJM 336: 1750-1751 [Full Text]  
• Gornick, M. E., Eggers, P. W., Reilly, T. W., Mentnech, R. M., Fitterman, L. K., Kucken, L. E., Vladeck, B. C. (1996). Effects of Race and Income on Mortality and Use of Services among Medicare Beneficiaries. NEJM 335: 791-799 [Abstract] [Full Text]  
• Butler, R. N. (1996). On Behalf of Older Women -- Another Reason to Protect Medicare and Medicaid. NEJM 334: 794-796 [Full Text]  
• Selby, J. V., Fireman, B. H., Swain, B. E. (1996). Effect of a Copayment on Use of the Emergency Department in a Health Maintenance Organization. NEJM 334: 635-642 [Abstract] [Full Text]  
• Sommer, A. (1995). Disease Prevention and Health Promotion-Reply. Arch Ophthalmol 113: 1356-1356 [Abstract]  
• Rasell, M. E. (1995). Cost Sharing in Health Insurance -- A Reexamination. NEJM 332: 1164-1168 [Full Text]