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Payment Switch Barely Affects Mammograms For Poor

May 14, 2014
Written by: , Filed in: Breast Imaging, Practice Management
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Switching low-income women in Massachusetts from free, federally subsidized mammography screening to a system with insurance-based payments apparently had little effect on how often they received mammograms, according to a new study.

So, no real news and therefore no big deal, right?

Well, actually, it is a big deal, according to the editor of the journal that published the study:

There are lessons learned from the Massachusetts experience of health care reform that can help inform health care changes nationally.

So said Susan G. Kornstein, MD, editor-in-chief of Journal of Women’s Health and a professor of psychiatry and obstetrics and gynecology at Virginia Commonwealth University in Richmond, Virginia. She was quoted in a news release from the journal. The study itself was published online, with open access, last week.

The study looked at Massachusetts women who, during the period of 2004 through 2006, participated in the Women’s Health Network. That’s a state program, federally subsidized, that offered free screening tests for breast cancer, cervical cancer, and cardiovascular disease.

Health care in Massachusetts changed significantly after 2006, when the state implemented a new model based on near-universal health insurance. So the study subjects were contacted again during the period of 2008 to 2010. Most of the 1,214 subjects transitioned to some form of state-subsidized insurance. And mammography screening rates actually went up slightly, from 86 percent to 88 percent.

A closer look at the data revealed that mammography participation increased by 5 percent among women who enrolled in Commonwealth Care, the state-subsidized insurance plan from the Massachusetts health insurance exchange. Mammography rates declined among women who depended on Medicaid, Medicare, or unsubsidized private insurance.

“Importantly,” the study concludes, “in the diverse population we studied here, we note that a high percentage of women, particularly Hispanic and non-Hispanic Asian populations, required safety-net funds to pay for their preventive care.”

The study authors suggest, “Additional strategies may be needed to ensure continuous quality of care for low-income women who transition to Medicare or to unsubsidized private insurance-coverage products.”

* * *

New software uses mammogram images to create a “much more objective measurement than the doctors give today” of breast density, says one of its developers. For details, see our Facebook page.

Related CME seminar (up to 25 AMA PRA Category 1 credits™): The Breast Imaging and Intervention: A Comprehensive Review


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