Fax: (617) 264-6848
The impact of Medicaid coverage and reimbursement on access to diagnostic mammography
Article first published online: 2 SEP 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 23, pages 5566–5578, 1 December 2009
How to Cite
Schuur, J. D., Shah, A., Wu, Z., Forman, H. P. and Gross, C. P. (2009), The impact of Medicaid coverage and reimbursement on access to diagnostic mammography. Cancer, 115: 5566–5578. doi: 10.1002/cncr.24637
- Issue published online: 19 NOV 2009
- Article first published online: 2 SEP 2009
- Manuscript Revised: 20 MAY 2009
- Manuscript Accepted: 20 MAY 2009
- Manuscript Received: 23 DEC 2008
- Beeson Career Development. Grant Number: 1 K08 AG24842
- Americans Independence Center at Yale. Grant Number: P30AG21342
- access to healthcare;
- health policy;
- health insurance reimbursement
Women of low socioeconomic status are at risk for delayed evaluation of abnormal mammograms and later stage presentations of breast cancer. Medicaid reimbursement for clinical services is lower than Medicare reimbursement, yet it is unclear whether low Medicaid reimbursement is a barrier to accessing mammography. The objective of the current study was to determine the association between reported insurance type (Medicaid vs Medicare), Medicaid reimbursement rate, and access to diagnostic mammography (DM).
Standardized patients (SPs) called 521 mammography facilities in defined geographic regions of 11 states in 2005. Facilities were divided between high, middle, and low reimbursing states based on the state's relative Medicaid-to-Medicare reimbursement rate for DM. SPs contacted each facility twice to schedule a DM using the same clinical vignette but switching insurance status (Medicaid vs Medicare). The authors measured the proportion of SPs who were offered 1) any appointment and 2) a timely appointment, defined as a third available appointment within 20 business days.
SPs with Medicaid were less likely to receive an appointment than SPs with Medicare (91% vs 99.1%; difference, 8.1%; 95% confidence interval, 5.3%-10.9% [P < .001]). Among facilities that offered appointments to both callers, the proportion of timely appointments did not differ between Medicaid (93.7%) and Medicare (92.9%; P = .51). States' Medicaid reimbursement rates for DM were not associated with the percentage of SPs with Medicaid who were offered any appointment (P = .50) or a timely appointment (P = .69).
Callers with Medicaid were offered appointments for DM less frequently than callers with Medicare, although both were widely accepted. State Medicaid reimbursement rates did not affect access to mammography. Cancer 2009. © 2009 American Cancer Society.