Medicare & medicaid research review最新文献

{"title":"Methodological issues in using multiple years of the Medicare current beneficiary survey.","authors":"Becky A Briesacher,&nbsp;Jennifer Tjia,&nbsp;Chyke A Doubeni,&nbsp;Yong Chen,&nbsp;Sowmya R Rao","doi":"10.5600/mmrr.002.01.a04","DOIUrl":"https://doi.org/10.5600/mmrr.002.01.a04","url":null,"abstract":"<p><strong>Background: </strong>The analysis presented in this paper examines the multi-year capacity of the Medicare Current Beneficiary Survey (MCBS).</p><p><strong>Methods: </strong>We systematically reviewed the literature for methodological approaches in research using multiple years of the MCBS and categorized the studies by study design, use of survey sampling weights, and variance adjustments. We then replicated the approaches in an empirical demonstration using functional status (activities of daily living (ADL) and 2005-2007 MCBS data.</p><p><strong>Results: </strong>In the systematic review, we identified 22 pooled, 17 repeated cross-sectional, and 17 longitudinal studies. Less than half of these studies explicitly described the weighting approach or variance estimation. In the empirical demonstration, we showed that different study designs and weighting approaches will yield statistically different estimates.</p><p><strong>Conclusion: </strong>There is a variety of methodological approaches when using multiple years of the MCBS, and some of them provide biased results. Research needs to improve in describing the methods and preferred approaches for using these complex data.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006385/pdf/mmrr2012-002-01-a04.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32318200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of cost-sharing reductions on preventive service use among Medicare fee-for-service beneficiaries.","authors":"Suzanne M Goodwin,&nbsp;Gerard F Anderson","doi":"10.5600/mmrr.002.01.a03","DOIUrl":"https://doi.org/10.5600/mmrr.002.01.a03","url":null,"abstract":"<p><strong>Background: </strong>Section 4104 of the Patient Protection and Affordable Care Act (ACA) waives previous cost-sharing requirements for many Medicare-covered preventive services. In 1997, Congress passed similar legislation waiving the deductible only for mammograms and Pap smears. The purpose of this study is to examine the effect of the deductible waiver on mammogram and Pap smear utilization rates.</p><p><strong>Methods: </strong>Using 1995-2003 Medicare claims from a sample of female, elderly Medicare fee-for-service beneficiaries, two pre/post analyses were conducted comparing mammogram and Pap smear utilization rates before and after implementation of the deductible waiver. Receipt of screening mammograms and Pap smears served as the outcome measures, and two time measures, representing two post-test observation periods, were used to examine the short- and long-term impacts on utilization.</p><p><strong>Results: </strong>There was a 20 percent short-term and a 25 percent longer term increase in the probability of having had a mammogram in the four years following the 1997 deductible waiver. Beneficiaries were no more likely to receive a Pap smear following the deductible waiver.</p><p><strong>Conclusions: </strong>Elimination of cost sharing may be an effective strategy for increasing preventive service use, but the impact could depend on the characteristics of the procedure, its cost, and the disease and populations it targets. These historical findings suggest that, with implementation of Section 4104, the greatest increases in utilization will be seen for preventive services that screen for diseases with high incidence or prevalence rates that increase with age, that are expensive, and that are performed on a frequent basis.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006388/pdf/mmrr2012-002-01-a03.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32318201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of continued biased disenrollment from the Medicare Advantage Program to fee-for-service.","authors":"Gerald F Riley","doi":"10.5600/mmrr.002.04.a08","DOIUrl":"https://doi.org/10.5600/mmrr.002.04.a08","url":null,"abstract":"<p><strong>Background: </strong>Medicare managed care enrollees who disenroll to fee-for-service (FFS) historically have worse health and higher costs than continuing enrollees and beneficiaries remaining in FFS.</p><p><strong>Objective: </strong>To examine disenrollment patterns by analyzing Medicare payments following disenrollment from Medicare Advantage (MA) to FFS in 2007. Recent growth in the MA program, introduction of limits on timing of enrollment/disenrollment, and initiation of prescription drug benefits may have substantially changed the dynamics of disenrollment.</p><p><strong>Study design: </strong>The study was based on MA enrollees who disenrolled to FFS in 2007 (N=248,779) and a sample of \"FFS stayers\" residing in the same counties as the disenrollees (N=551,616). Actual Medicare Part A and Part B payments (excluding hospice payments) in the six months following disenrollment were compared with predicted payments based on claims experience of local FFS stayers, adjusted for CMS-Hierarchical Condition Category (CMS-HCC) risk scores.</p><p><strong>Results: </strong>Disenrollees incurred $1,021 per month in Medicare payments, compared with $798 in predicted payments (ratio of actual/predicted=1.28, p < 0.001). Differences between actual and predicted payments were smaller for disenrollees of Preferred Provider Organizations and Private Fee-for-Service plans than of Health Maintenance Organizations. Analysis of 10 individual MA plans revealed variation in the degree of selective disenrollment.</p><p><strong>Conclusions: </strong>Despite substantial changes in policies and market characteristics of the Medicare managed care program, disenrollment to FFS continues to occur disproportionately among high-cost beneficiaries, raising concerns about care experiences among sicker enrollees and increased costs to Medicare.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006478/pdf/mmrr2012-002-04-a08.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32319044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicare managed care plan performance: a comparison across hospitalization types.","authors":"Jayasree Basu,&nbsp;Lee Rivers Mobley","doi":"10.5600/mmrr.002.01.a02","DOIUrl":"https://doi.org/10.5600/mmrr.002.01.a02","url":null,"abstract":"<p><strong>Objective: </strong>The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures.</p><p><strong>Study design/methods: </strong>Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with 'marker' admissions and 'referral-sensitive' admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period.</p><p><strong>Findings: </strong>MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)-while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)-of referral-sensitive (versus marker) admissions compared to their FFS counterparts.</p><p><strong>Conclusion: </strong>While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection bias.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006392/pdf/mmrr2012-002-01-a02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32318202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department utilization in the Texas Medicaid emergency waiver following Hurricane Katrina.","authors":"Troy Quast,&nbsp;Karoline Mortensen","doi":"10.5600/mmrr.002.01.a01","DOIUrl":"https://doi.org/10.5600/mmrr.002.01.a01","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the enrollment and emergency department (ED) utilization in TexKat, the Texas Medicaid emergency waiver implemented following Hurricane Katrina.</p><p><strong>Data sources: </strong>Individual-level enrollment and utilization data from the 2005 Medicaid Analytic Extract.</p><p><strong>Study design: </strong>Descriptive analysis is performed on variables that describe enrollment levels, the demographic characteristics of enrollees, and the most common diagnoses in ED visits. A Poisson regression model is also employed to quantify the factors related to an enrollee's probability of having an ED visit and the average number of ED visits.</p><p><strong>Principal findings: </strong>There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13% of these enrollees had at least one ED visit during the sample period, with one quarter of these individuals having more than one visit. Across all enrollees the most common diagnosis was \"other upper respiratory infection,\" but there were significant differences in diagnosis patterns across racial/ethnic groups. The regression analysis suggests little difference in ED utilization across genders, but significant contrasts across racial/ethnic and age groups.</p><p><strong>Conclusions: </strong>As very little is known about Medicaid emergency waivers, our analysis may provide important information to policymakers who have to react quickly following a disaster. Our findings may help providers estimate potential increases in ED utilization and prepare for relatively common diagnoses. Furthermore, the analysis across racial/ethnic groups may help government officials identify important areas for outreach among vulnerable populations.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006383/pdf/mmrr2012-002-01-a01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32318199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flu shots and the characteristics of unvaccinated elderly Medicare beneficiaries.","authors":"Kimberly A Lochner,&nbsp;Marc Wynne","doi":"10.5600/mmrr.001.04.b01","DOIUrl":"https://doi.org/10.5600/mmrr.001.04.b01","url":null,"abstract":"<p><strong>Key findings: </strong>Data from the Medicare Current Beneficiary Survey, 2009. • Overall, 73% of Medicare beneficiaries aged 65 years and older reported receiving a flu shot for the 2008 flu season, but vaccination rates varied by socio-demographic characteristics. Flu vaccination was lowest for beneficiaries aged 65-74 years old, who were non-Hispanic Blacks and Hispanics, were not married, had less than a high school education, or who were eligible for Medicaid (i.e., dual eligibles). • Healthcare utilization and personal health behavior were also related to vaccination rates, with current smokers and those with no hospitalizations or physician visits being less likely to be vaccinated. • Among those beneficiaries who reported receiving a flu shot, 59% received it in a physician's office or clinic, with the next most common setting being in the community (21%); e.g., grocery store, shopping mall, library, or church. • Among those beneficiaries who did not receive a flu shot, the most common reasons were beliefs that the shot could cause side effects or disease (20%), that they didn't think the shot could prevent the flu (17%), or that the shot wasn't needed (16%). Less than 1% reported that they didn't get the flu shot because of cost. Elderly persons (aged 65 years and older) are at increased risk of complications from influenza, with the majority of influenza-related hospitalizations and deaths occurring among the elderly (Fiore et al., 2010). Most physicians recommend their elderly patients get a flu shot each year, and many hospitals inquire about elderly patient's immunization status upon admission, providing a vaccination if requested. The importance of getting a flu shot is underscored by the Department of Health and Human Services' Healthy People initiative, which has set a vaccination goal of 90% for the Nation's elderly by the year 2020 (Department of Health and Human Services [DHHS], 2011). Although all costs related to flu shots are covered by Medicare, requiring no co-pay on the part of the beneficiary (Centers for Medicare and Medicaid Services, 2011), for the 2008 flu season, only 73% of non-institutionalized Medicare beneficiaries, aged 65 years and older, reported receiving one. This report presents the most recent data on flu vaccination rates among non-institutionalized elderly Medicare beneficiaries and their association with socio-demographic and personal health characteristics. The report also describes the places beneficiaries received their flu shot and, for those not getting vaccinated, the reasons reported for not doing so.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010448/pdf/mmrr2011-001-04-b01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30465452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noncompliance in the use of cardiovascular medications in the Medicare Part D population.","authors":"Steven A Blackwell,&nbsp;David K Baugh,&nbsp;Melissa A Montgomery,&nbsp;Gary M Ciborowski,&nbsp;Charles J Waldron,&nbsp;Gerald F Riley","doi":"10.5600/mmrr.001.04.a05","DOIUrl":"https://doi.org/10.5600/mmrr.001.04.a05","url":null,"abstract":"<p><strong>Objectives: </strong>(1) to assess non-compliance among Medicare Part D recipients for the cardiovascular medication classes; (2) to identify the probability of noncompliance for each medication class when controlling for the potential risk factors of age, gender, race/ethnic origin, census region, disease burden, dual eligibility enrollment status, Part D plan status, relative out-of-pocket (OOP) non-class costs, and relative OOP daily class costs.</p><p><strong>Design: </strong>Cross sectional retrospective review of 2007 Centers for Medicare & Medicaid Services (CMS) Part D data. All drugs within a drug class were used to conduct the assessment.</p><p><strong>Findings: </strong>Non-compliance was found to be lower than previously reported. Patients who are male, age 65 to 74, Black, or residing in the South are associated with higher noncompliance for cardiovascular medications among the therapeutic classes we studied. Dual eligibility enrollment is typically associated with improved compliance; enrollment in a Medicare Advantage Prescription Drug (MAPD) plan may or may not improve compliance dependent on the therapeutic class under study. Increased disease burden is associated with lower compliance. OOP non-class costs had an opposing effect on compliance as compared to OOP daily costs; higher OOP non-class costs were associated with better compliance.</p><p><strong>Conclusion: </strong>Identifying patient characteristics that may contribute positively or negatively to medication compliance is an essential step to improved therapy. As a strategy to improve compliance, the proper selection of therapy that fits a particular patient is paramount.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010442/pdf/mmrr2011-001-04-a05.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30465451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine therapy use among elderly hormone receptor-positive breast cancer patients enrolled in Medicare Part D.","authors":"Gerald F Riley,&nbsp;Joan L Warren,&nbsp;Linda C Harlan,&nbsp;Steven A Blackwell","doi":"10.5600/mmrr.001.04.a04","DOIUrl":"https://doi.org/10.5600/mmrr.001.04.a04","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend that women with hormone-receptor positive breast cancer receive endocrine therapy (selective estrogen receptor modulators [SERMs] or aromatase inhibitors [AIs]) for five years following diagnosis.</p><p><strong>Objective: </strong>To examine utilization and adherence to therapy for SERMs and AIs in Medicare Part D prescription drug plans.</p><p><strong>Data: </strong>Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data.</p><p><strong>Study design: </strong>We identified 15,542 elderly women diagnosed with hormone-receptor positive breast cancer in years 2003-2005 (the latest SEER data at the time of the study) and enrolled in a Part D plan in 2006 or 2007 (the initial years of Part D). This permitted us to compare utilization and adherence to therapy at various points within the recommended five-year timeframe for endocrine therapy. SERM and AI use was measured from claim records. Non-adherence to therapy was defined as a medication possession ratio of less than 80 percent.</p><p><strong>Principal findings: </strong>Between May 2006 and December 2007, 22 percent of beneficiaries received SERM, 52 percent AI, and 26 percent received neither. The percent receiving any endocrine therapy decreased with time from diagnosis. Among SERM and AI users, 20-30 percent were non-adherent to therapy; out-of-pocket costs were higher for AI than SERM and were strongly associated with non-adherence. For AI users without a low income subsidy, adherence to therapy deteriorated after reaching the Part D coverage gap.</p><p><strong>Conclusions: </strong>Many elderly breast cancer patients were not receiving therapy for the recommended five years following diagnosis. Choosing a Part D plan that minimizes out-of-pocket costs is critical to ensuring beneficiary access to essential medications.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010443/pdf/mmrr2011-001-04-a04.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30465450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health spending by state of residence, 1991-2009.","authors":"Gigi Cuckler,&nbsp;Anne Martin,&nbsp;Lekha Whittle,&nbsp;Stephen Heffler,&nbsp;Andrea Sisko,&nbsp;Dave Lassman,&nbsp;Joseph Benson","doi":"10.5600/mmrr.001.04.a03","DOIUrl":"https://doi.org/10.5600/mmrr.001.04.a03","url":null,"abstract":"<p><strong>Objective: </strong>Provide a detailed discussion of baseline health spending by state of residence (per capita personal health care spending, per enrollee Medicare spending, and per enrollee Medicaid spending) in 2009, over the last decade (1998-2009), as well as the differential regional and state impacts of the recent recession.</p><p><strong>Data source: </strong>State Health Expenditures by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary.</p><p><strong>Principal findings: </strong>In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita spending was lowest ranged from 8 to 26 percent below the national average. States with the highest per capita spending tended to have older populations and the highest per capita incomes; states with the lowest per capita spending tended to have younger populations, lower per capita incomes, and higher rates of uninsured. Over the last decade, the New England and Mideast regions exhibited the highest per capita personal health care spending, while states in the Southwest and Rocky Mountain regions had the lowest per capita spending. Variation in per enrollee Medicaid spending, however, has consistently been greater than that of total per capita personal health care spending or per enrollee Medicare spending from 1998-2009. The Great Lakes, New England, and Far West regions experienced the largest slowdown in per person health spending growth during the recent recession, largely as a result of higher unemployment rates.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010453/pdf/mmrr2011-001-04-a03.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in routine breast cancer screening for Medicaid managed care members with a work-limiting disability.","authors":"Sharada Weir,&nbsp;Heather E Posner,&nbsp;Jianying Zhang,&nbsp;Whitney C Jones,&nbsp;Georgianna Willis,&nbsp;Jeffrey D Baxter,&nbsp;Robin E Clark","doi":"10.5600/mmrr.001.04.a02","DOIUrl":"https://doi.org/10.5600/mmrr.001.04.a02","url":null,"abstract":"<p><strong>Objective: </strong>Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability.</p><p><strong>Methods: </strong>Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screening measure (n=35,171). Disability status was determined from Medicaid eligibility records. Mammography screening was modeled using multivariate logistic regression. Separate models for women with and without a disability were also estimated.</p><p><strong>Results: </strong>Although unadjusted breast cancer screening rates were roughly equal for women with and without disability, after adjusting for confounders disability status had a significant negative association with screening mammography (OR=0.74; p<0.0001). Living farther from a mammography facility or having a diagnosis of domestic violence reduced the odds of screening for women with disabilities, but not for other women. Having a higher illness burden was more detrimental to screening for women with a disability than for those without. Both groups benefited similarly from the first 26 ambulatory care visits, but the impact of additional visits on screening was much larger among women with disabilities.</p><p><strong>Conclusion: </strong>Nationwide, rates of routine mammography for Medicaid managed care plans averaged below 50% in 2006. Given that a majority of eligible women served by Medicaid have disabilities, and studies have shown that women with disabilities are more likely to be diagnosed with late stage disease, a focus on improving rates of screening for women with disabilities is overdue.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010450/pdf/mmrr2011-001-04-a02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}