Statement of problem. In the 1990s, Congress became concerned that Medicare's cost-sharing requirements were deterring women from getting mammograms and Pap smears. To increase utilization rates, Congress eliminated the Part B deductible for these two preventive services. This study assessed whether the deductible waiver was effective in increasing mammogram and Pap smear use and to understand how different groups responded to the policy change.
Methods. Medicare claims data from the Five Percent Sample Beneficiary Standard Analytic File were used to perform longitudinal logistic regressions on two samples of elderly women (N=481,630 and 380,994) comparing their mammogram and Pap smear use before and after introduction of the deductible waiver. The results were compared to a period when there were no major interventions aimed at increasing utilization rates. Interaction terms were included to assess whether the effect of the deductible waiver on preventive service differed by age, race, income, education, Medicaid enrollment, health status, frequency of health care encounters, and propensity to seek preventive care.
Results. The Part B deductible waiver was shown to have an immediate, positive, and persistent effect on mammogram use and to have slowed temporarily the usual decrease in Pap smear use seen in this population. Also, the effect of the deductible waiver on mammogram use was greater for beneficiaries not enrolled in Medicaid, who had more provider visits, and who were White. The waiver's effect on Pap smear use was greater for beneficiaries with no chronic conditions, with a greater propensity to seek preventive care, and who were Hispanic. The deductible waiver did not have a greater impact on beneficiaries living in low-income areas.
Conclusions. Medicare Part B deductible waivers are an effective strategy for increasing preventive service use and should be implemented for other preventive services. However, the degree and duration of effectiveness depend on characteristics of the procedure, its cost, and the disease and populations it targets. Although deductible waivers are effective, additional efforts are needed to increase preventive service use among groups that have below-average utilization rates.
|Advisor:||Anderson, Gerard F.|
|School:||The Johns Hopkins University|
|School Location:||United States -- Maryland|
|Source:||DAI-B 70/04, Dissertation Abstracts International|
|Subjects:||Gerontology, Public health, Health care management|
|Keywords:||Cancer, Cost sharing, Mammograms, Medicare, Pap smears, Preventive services|
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