The impact of medicare funding on the use of mammography among older women: Implications for improving access to screening

Background In 1991, a policy change extended financial coverage for biennia l mammography to holders of Medicare part B, The impact of this decision on mammography use was examined by comparing mammography use among Medicare-e ligible and ineligible women in the years before (1990) and after (1993) th e policy change, using National Health Interview Survey (NHIS) data, contro lling for socioeconomic indicators and for having a usual source of medical care. Methods. The Medicare-eligible group consists of 2,419 women ages 65-69 yea rs and women ages 60-64 years who are Medicare-eligible. The Medicare-ineli gible group consists of 1,872 women ages 60-64 years. The analysis used log istic regressions and compared women who had undergone mammography in the p rior 2 years and controlled for race, ethnicity, socioeconomic status, insu rance status, and usual source of care. Results. Medicare reimbursement of mammography appears to have increased th e number of Medicare-eligible women who had had a mammogram in the 2 years prior to the survey. However, the analyses suggested that disparities in ma mmography use due to access to primary care and socioeconomic status persis ted after the change in Medicare coverage. Analyses indicated that having a dditional insurance was the only significant predictor of having a usual so urce of care among the Medicare population. Conclusions. This analysis suggests that simply removing financial barriers to mammography for older women (such as the 1998 elimination of a deductib le payment for mammograms provided under Medicare) may have limited effecti veness. The strong relationship between having a usual source of care and m ammography suggests that disparities in mammography use may reflect inequal ities in access to health care in general. (C) 2000 American Health Foundat ion and Academic Press.