Screening programs can be highly effective tools in reducing the burden of certain illnesses within the population. With the expansion of Medicaid under the Affordable Care Act, more patients will have access to these screening exams and be able to receive all services at the recommended time intervals. It has been shown that low-income patients with Medicaid, compared to patients without insurance, utilize preventative care services at significantly higher rates, have lower out-of pocket medical expenditures, and report better physical and mental health.
However, a recent study of women’s health visits demonstrated that differences in access to care exist between Medicaid versus privately insured patients. McMorrow, et al. found that Medicaid-insured patients are less likely than privately insured patients to receive preventive care measures at the recommended time intervals. The study examined five different preventive services included in the well-woman exam: clinical breast exam, pelvic exam, mammograms, Pap tests, and depression screening. Of the clinic visits included in the study, 31% of privately insured women received at least one of the services while only 26% of Medicaid insured women received one or more of the screening tests.
Current guidelines for female screenings from the American Congress of Obstetricians and Gynecologists include:
- beginning at age 21, an annual well-woman exam with a pelvic exam and depression screening.
- beginning at age 21, a pap smear every three years to screen for cervical cancer.
- for women without significant risk factors for breast cancer, a clinical breast exam every one to three years between 20-39, and annual exams starting at 40.
Image Source: David McNew / Staff
Although the differences in the screening rates were not statistically significant in this study, meaning that the results may have been due to chance, the disparity raises several important issues. The first issue is the importance of providing equal services for all patients, regardless of income or insurance status. Second is the need to place an emphasis on adequate insurance reimbursement for screening programs to encourage all medical providers to adequately screen their patients.
Successful screening programs result in early detection, reduction in mortality, and better outcomes for women. A Swedish study found that implementation of the Pap smear screening program resulted in a 53% reduction in cervical cancer mortality. Therefore, it is essential that all patients, regardless of insurance status, are able to receive the same standard of care in preventative services.
Feature Image Source: National Eye Institute