Medicaid recipients age 50 and older are falling short of national cancer screening objectives. According to a report published in the October 13 issue of Archives of Internal Medicine, only about half receive colorectal, breast, and cervical cancer screening tests that the government recommends.

Cancers of the colon, breast, and cervix can be detected early and have the potential to be cured. Part of the government’s Healthy People 2010 plan is to remove screening disparities between different socioeconomic groups. Researcher C. Annette DuBard, M.D., M.P.H. (North Carolina Department of Health and Human Services, Raleigh, and University of North Carolina at Chapel Hill Cecil G. Sheps Center for Health Services Research) and colleagues write that, “State Medicaid agencies are in a unique position to monitor and improve the quality of care received by some of the nation’s most vulnerable citizens.” They add that, “Medicaid is the largest provider of health insurance for minority populations in America. Medicaid recipients, by virtue of Medicaid eligibility criteria, frequently share other characteristics associated with health-related disparities: low income, old age, and/or chronic disability because of advanced disease, physical limitation, severe mental illness or developmental disability.”

DuBard and colleagues examined the medical records of 1,951 North Carolina Medicaid recipients age 50 and older. The researchers were interested in determining whether physicians recommended cancer screenings to the patients and whether patients had received cancer screening examinations.

The authors found: “Documentation that colorectal, breast and cervical cancer screening was recommended by the primary care provider was found for only 52.7 percent, 60.4 percent and 51.5 percent of eligible patients, respectively…Documented rates of adequate screening were 28.2 percent for colorectal cancer, 31.7 percent for mammography within two years and 31.6 percent for Papanicolaou [cervical cancer] test within three years. When medical record and claims data were combined, approximately half of eligible patients had evidence of screening.”

The screening rates for Medicaid recipients were found to be much lower than the rates for the general population even though Medicaid recipients have access to primary care and full coverage of cancer screening services. “Lack of a screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency,” explain the authors. “Efforts to increase cancer screening rates among Medicaid recipients must address patient, physician and organizational barriers to the routine identification and delivery of preventive services.”

Recommendation for and Receipt of Cancer Screenings Among Medicaid Recipients 50 Years and Older
C. Annette DuBard, MD, MPH; Dorothee Schmid, MA; Angie Yow, RN; Anne B. Rogers, BSN, RN, MPH; William W. Lawrence, MD
Archives of Internal Medicine (2008); 168[18]: pp. 2014-2021.
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Written by: Peter M Crosta