The impact of Medicaid coverage and reimbursement on access to diagnostic mammography.
The impact of Medicaid coverage and reimbursement on access to diagnostic mammography.
复制标题
医疗补助覆盖范围和报销对获得诊断性乳房X光检查的影响。
作者：
Schuur,JeremiahD;Shah,Akash;Wu,Zheyang;Forman,HowardP;Gross,CaryP
社会经济地位低的妇女有延迟评估异常乳房X线照片和晚期乳腺癌表现的风险。医疗补助对临床服务的报销低于医疗保险的报销，但目前还不清楚低医疗补助报销是否是获得乳房X光检查的障碍。本研究的目的是确定报告的保险类型（医疗补助与医疗保险），医疗补助报销率，并获得诊断性乳房X线摄影（DM）之间的关联。METHODS标准化的患者（SP）在2005年11个州的定义的地理区域称为521乳房X线摄影设施。根据州医疗补助对医疗保险的相对DM报销率，将设施分为高、中、低报销州。SP联系每个机构两次，以使用相同的临床小插曲安排DM，但转换保险状态（医疗补助与医疗保险）。作者测量了获得1）任何预约和2）及时预约（定义为20个工作日内的第三次预约）的SP比例。接受医疗补助的医疗服务提供者接受预约的可能性低于接受医疗保险的SP（91% vs 99.1%;差异为8.1%; 95%置信区间为5.3%-10.9% [P< .001]）。在向两个呼叫者提供预约的设施中，医疗补助（93.7%）和医疗保险（92.9%;P= .51）之间及时预约的比例没有差异。国家的医疗补助报销率DM与医疗补助的SP谁提供任何预约（P= 0.50）或及时的任命（P= 0.69）。CONCLUSIONSCallers与医疗补助的比例没有相关的医疗保险的呼叫者提供预约DM的频率低于呼叫者，虽然两者都被广泛接受。州医疗补助报销率并不影响乳房X光检查。2009年癌症。© 2009美国癌症协会。
BACKGROUNDWomen 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).METHODSStandardized 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.RESULTSSPs 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).CONCLUSIONSCallers 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.