MEDICARE COVERAGE, SUPPLEMENTAL INSURANCE, AND THE USE OF MAMMOGRAPHY BY OLDER WOMEN
MEDICARE COVERAGE, SUPPLEMENTAL INSURANCE, AND THE USE OF MAMMOGRAPHY BY OLDER WOMEN
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DOI：
10.1056/nejm199504273321706
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发表时间：
1995-04-27
影响因子：
158.5
通讯作者：
BLUSTEIN, J
中科院分区：
文献类型：
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作者：
BLUSTEIN, J
背景1998年1月1日，医疗保险计划开始为每两年一次的乳房X光检查提供报销。本研究调查了在提供筛查福利的前两年，医疗保险覆盖的妇女使用乳房X光检查的情况。1991年和1992年的医疗保险法案从全国代表性的样本4110名65岁或以上的妇女进行了检查，以确定程度的遵守公认的指导方针，筛查乳房X线摄影和乳房X线摄影的使用程度与补充保险，这使患者从使用医疗保险福利相关的自付费用。在医疗保险福利的头两年，共有36.9%的美国老年妇女接受了乳房X光检查。在没有补充保险的妇女中，只有14.4%的人做了乳房X光检查，而在雇主赞助的补充保险中，这一比例为44.7%，在自费购买的补充保险中，这一比例为40.1%，在医疗补助补充保险中，这一比例为23.9%。这些差异在分层和多变量分析中持续存在。与没有补充保险的妇女相比，有就业补充保险的妇女更有可能接受乳房X光检查（调整后的比值比为3.03; 95%置信区间为2.17 - 4.23），自购补充保险的女性也是如此。（调整优势比，2.97; 95%可信区间，2.13 ~ 4.15）和有医疗补助补充保险的妇女（调整优势比，1.99; 95%可信区间，1.30 ~ 3.07）。在医疗保险覆盖的前两年，乳房X光检查的使用大大低于推荐水平。没有补充医疗保险的妇女尤其有可能无法接受乳房X光检查。要求预防服务自付费用是对老年妇女进行有效大规模乳腺癌筛查的障碍。
Background. On January 1, 1998, the Medicare program began offering reimbursement for screening mammography every two years. This study examined the use of mammography in women covered by Medicare during the first two years that the screening benefit was offered.Methods. Medicare bills for 1991 and 1992 from a nationally representative sample of 4110 women 65 years of age or older were examined to determine the degree of compliance with recognized guidelines for screening mammography and the extent to which the use of mammography was associated with having supplemental insurance, which shields patients from the out-of-pocket 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 percent of the women lacking supplemental insurance had mammography, as compared with 44.7 percent of those with employer-sponsored supplemental insurance, 40.1 percent of those with self-purchased supplemental insurance, and 23.9 percent of those with Medicaid supplemental insurance. These differences persisted in the stratified and multivariate analyses. As compared with women lacking supplemental insurance, women with employment-based supplemental insurance were more likely to undergo mammography (adjusted odds ratio, 3.03; 95 percent confidence interval, 2.17 to 4.23), as were women with self-purchased supplemental insurance (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).Conclusions. The use of mammography was substantially below recommended levels during the first two years of Medicare coverage for screening mammography. 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.