Medicare options go unused, study says

Beneficiaries not getting mammograms, tests for colon-rectal cancer

April 19, 1999|By LOS ANGELES TIMES

WASHINGTON -- Although Medicare pays for preventive tests such as mammograms and colon-rectal cancer screenings, the vast majority of Medicare beneficiaries do not take advantage of these tests that might someday save their lives, a major national study will report today.

According to the Dartmouth Atlas of Health Care, a detailed annual review of patterns of medical practice, most elderly patients and their doctors are not ordering the tests, even though Medicare will cover all or most of the cost, depending on the procedure.

The low rate of preventive screenings should awaken patients to demand better checkups and for doctors to perform preventive care, said Dr. Jonathan Lord, quality expert at the American Hospital Association, which publishes the atlas.

The study found, for example, that although all women from the ages of 65 to 69 should have a mammogram every two years, only 28 percent of women in this age group had a mammogram during the 1995-1996 period.

Similarly, screening for colorectal cancer, either by a blood test or a colonoscopy, should be performed annually on people older than 65, but only 12 percent of the Medicare beneficiaries received the test.

And the approximately 1.7 million Medicare beneficiaries with diabetes should receive annual eye exams, as well as annual glucose level checks and twice-yearly measurements of cholesterol. Yet a survey of the prevalence of eye examinations showed it as low as 25 percent in some areas.

Health maintenance organizations, although they are targets of criticism on some issues, almost always have better performance records when it comes to screening tests than the traditional fee-for-service Medicare system, in which patients are free to select any doctor who is participating in Medicare, said Dr. John Wennberg of Dartmouth Medical School, the atlas' editor.

The HMOs typically have better systems for gathering information, and businesses deciding which HMO to select for their workers often pay attention to the screening statistics, Wennberg said.

Nationally, about 15 percent of the 40 million Medicare beneficiaries are enrolled in HMOs.

The third edition of the Dartmouth Atlas demonstrates that a person's place of residence strongly influences that person's likelihood of having preventive screening tests or undergoing various surgical procedures.

"Geography seems to be destiny in health services," Lord said. "There is not a national system of health care. Instead, we have a lot of local markets where we practice medicine by tradition."

In addition to screenings, older patients should be vaccinated for pneumococcal pneumonia every 10 years, but the rates of vaccination range from 9 percent to 38 percent.

Medical directors at managed care organizations attribute their higher preventive care rates to an array of factors including extensive computer systems that track patient care.

The benchmark, or best performance, was by Kaiser, which had an 80 percent rate of providing mammograms in 1995-1996, the period covered by the study.

Pub Date: 4/19/99

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