MEDICARE COVERAGE, SUPPLEMENTAL INSURANCE, AND THE USE OF MAMMOGRAPHYBY OLDER WOMEN

Background. On January 1, 1998, the Medicare program began offering re imbursement for screening mammography every two years. This study exam ined the use of mammography in women covered by Medicare during the fi rst two years that the screening benefit was offered. Methods. Medicar e bills for 1991 and 1992 from a nationally representative sample of 4 110 women 65 years of age or older were examined to determine the degr ee of compliance with recognized guidelines for screening mammography and the extent to which the use of mammography was associated with hav ing supplemental insurance, which shields patients from the out-of-poc ket 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 pe rcent of the women lacking supplemental insurance had mammography, as compared with 44.7 percent of those with employer-sponsored supplement al insurance, 40.1 percent of those with self-purchased supplemental i nsurance, and 23.9 percent of those with Medicaid supplemental insuran ce. These differences persisted in the stratified and multivariate ana lyses. As compared with women lacking supplemental insurance, women wi th employment-based supplemental insurance were more likely to undergo mammography (adjusted odds ratio, 3.03; 95 percent confidence interva l, 2.17 to 4.23), as were women with self-purchased supplemental insur ance (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). Conclusio ns. The use of mammography was substantially below recommended levels during the first two years of Medicare coverage for screening mammogra phy. 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.