According to a recent study conducted by researchers at the Urban Institute, gynecologists are ordering fewer preventive services for female Medicaid recipients than for those who have private insurance. According to Kaiser Health News, the services in question were clinical breast exams, PAP tests, pelvic exams, mammograms and depression screening.
What the results say
Data for the study was gleaned from the National Ambulatory Medical Survey, a federal database of services provided by physicians in physician offices. The researchers reviewed data from 12,444 primary care visits by women with private insurance and 1,519 visits by those who were covered by Medicaid over a five-year period (2006-2010). The large gap in the number of visits studied was to account for the fact that there are seven times more women with private insurance than there are on Medicaid.
Overall, 26% of Medicaid recipients received one of the five services during their visits compared to 31% of woman who were privately insured. But once patient demographics such as age, race and geographic location of residency were factored in, the differences were not statistically significant for clinical depression screening, mammograms or pelvic exams. The study did find "strong evidence" that visits by women with Medicaid coverage were less likely to include a clinical breast exam or PAP test. In fact, 20.5% of visits by those with private insurance included a clinical breast exam and 16.5% included a PAP tests; whereas only 12% of visits by women with Medicaid coverage included a clinical breast exam and only 9.5% included a PAP test.
Flaws in methodology?
Although these numbers might be enough to initially spark public outrage, when you dig a little deeper, the study admittedly has some flaws. The researchers even say that their findings do not mean that Medicaid recipients are receiving suboptimal care. For instance, the study only looks at care provided by physicians at physician offices. It does not take into account care that Medicaid recipients may have received in other outpatient settings, such as community clinics, or care provided by nurse practitioners.
There's also a good possibility that women with private insurance are requesting more preventive services than those who are on Medicaid. For example, new cervical cancer screening guidelines that were released separately by the United States Preventive Services Task Force and the American Cancer Society recommend PAP testing every three years for women ages 21-65; routine cervical cancer screening for women under 21 and over 65 is no longer recommended. However, many women who have private insurance may still be operating under the old guidelines and requesting PAP tests annually. Newly-insured Medicaid recipients were likely not receiving annual PAP tests in the past, so they would be more apt to follow the new guidelines as recommended by their providers.
Still, Stacey McMorrow, a senior research associate at the Urban Institute's Health Policy Center and the study's lead author, does make a valid point that bears some consideration. "Private insurers generally pay providers better than does Medicaid, sometimes significantly better," she says. "Where providers are getting reimbursed better, they're going to provide services more frequently."