Preventive services among medicare beneficiaries with supplemental coverage versus HMO enrollees, Medicaid recipients, and elders with no additional coverage

BACKGROUND. Studies conducted when Medicare began to cover preventive servi ces, found that beneficiaries with supplemental insurance were much more li kely to have such services than those without additional coverage. OBJECTIVE. TO examine preventive services among Medicare beneficiaries with supplemental insurance, Medicaid, health maintenance organization (HMO) en rollees, and those without additional insurance. RESEARCH DESIGN. Analysis of the 1996 Medical Expenditure Panel Survey, a n ationally representative multistage survey. SUBJECTS. 2,251 persons aged 65 and older with Medicare coverage. MEASURES. Self-reported preventive services, specifically, blood pressure m easurement, cholesterol testing, influenza vaccination, mammography, Papani colau (Pap) testing, and breast and prostate examinations. Multivariate mod eling was used to adjust for age, education, race/ethnicity, and functional status. RESULTS. Elders without additional coverage were approximately 10% points l ess likely to have influenza vaccination, cholesterol testing, mammography, or Pap smears than those with supplemental coverage (P <0.05), Multivariat e adjustment attenuated some of these differences with age and education be ing the most important predictors of having preventive services. HMO enroll ees were more likely to have mammograms than those with supplemental covera ge (P <less than>0.05). CONCLUSIONS. Several years after Medicare extended coverage to include prev entive services, differences in utilization of such services among elders w ith and without supplemental insurance have narrowed substantially.