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Despite Medicare coverage of preventive care services, wealth, age, education, and race continue to be important factors in the receipt of preventive services by older women, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS09630). Women aged 65 and older who were enrolled in one of two Medicare+Choice HMOs and lived in wealthier households were 11 to 17 percent more likely than women in the lowest wealth category to receive a mammogram and colorectal cancer (CRC) screening. They also received a greater average number of preventive services.
Women who had a college or higher education were more likely to receive CRC screening, and they received a greater average number of preventive services than women without a high school education. Finally, compared with white women, black women were more likely to receive CRC screening and less likely to receive influenza vaccinations.
Having primary care providers (PCPs) serving as gatekeepers may increase the use of preventive services, notes lead investigator Leo S. Morales, M.D., Ph.D., of RAND Health and the University of California, Los Angeles. Women enrolled in the Northeastern plan that required PCPs to function as gatekeepers had higher rates of mammography, CRC screening, and influenza vaccinations, and they received a greater number of preventive services compared with women enrolled in the Midwest plan that did not use gatekeepers.
The gatekeeper role may foster regular patient-provider relationships that, in turn, may promote use of preventive services, especially by low-income people. Medicare+Choice plans should consider strategies to further reduce racial and wealth disparities in use of preventive services, according to Dr. Escarce and his colleagues. Their findings were based on analysis of administrative and survey data for 2,698 women enrolled in the two Medicare+Choice plans.
More details are in "Sociodemographic differences in use of preventive services by women enrolled in Medicare+Choice plans," by Dr. Morales, Jeannette Rogowoski, Ph.D., Vicki A. Freedman, Ph.D., and others, in the October 2004 Preventive Medicine 39(4), pp. 738-745.
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