Differences in the frequency of cholesterol screening in patients with Medicaid compared with private insurance
W. J. Hueston, E. Spencer and R. Kuehn
Department of Family Medicine, University of Wisconsin-Madison, USA.
OBJECTIVE: To assess compliance with preventive screening for Medicaid
recipients compared with individuals with equal access to preventive
services. SETTING: A community-based family practice residency program.
METHODS: Survey of a consecutive sample of English-reading individuals,
aged 18 to 50 years, with Medicaid (n = 98) or private insurance (n = 75),
who had scheduled appointments in the clinic. MAIN RESULTS: Patients with
Medicaid were as likely as those with private insurance to be screened for
hypertension and cervical cancer in the last 5 years but were less likely
to have received cholesterol screening (39% vs 65%, P < .001). Even
after adjusting for differences in gender composition, age, race, marital
status, and education level attained, patients with Medicaid were still
less likely to have received cholesterol screening (odds ratio, 0.43; 95%
confidence interval, 0.21 to 0.57). Although patients with Medicaid were no
more likely to identify a barrier and, when identifying barriers, did not
identify significantly more barriers than patients with private insurance,
Medicaid recipients were less likely to state that cholesterol testing had
been recommended by their physician (30% vs 44%, P = .05). CONCLUSIONS:
Because access to screening tests by patients with Medicaid is equal to or
better than that of those with insurance, differences in the frequency of
cholesterol screening should not reflect financial barriers. Differences in
the attention paid to screening by physicians and differences in cultural
beliefs about the importance of screening may play a role in the underuse
of screening services by individuals in lower socioeconomic groups.
