The effect of Medicare Advantage enrollment on mammographic screening.

OBJECTIVES: To compare the rates of mammographic screening and reasons for not receiving mammography between Medicare Advantage (MA) and Medicare fee-for-service (FFS) beneficiaries. STUDY DESIGN: Cross-sectional study. METHODS: Unadjusted rates of mammographic screening and reasons for not receiving mammography were compared between MA and FFS beneficiaries in total and within subgroups. Probabilities of mammographic screening were also compared between the MA and FFS beneficiaries after adjusting for age, education, race/ethnicity, health status, marriage status, and region of residence using modified Poisson regression models. RESULTS: We found significantly higher unadjusted rates of mammographic screening in the MA beneficiary population compared with the FFS population (50.3% vs 44%, respectively; P < .0001). MA beneficiaries were more likely to receive a mammogram than FFS beneficiaries (unadjusted relative risk [RR], 1.13; 95% CI, 1.07-1.19; and adjusted RR, 1.06; 95% CI, 1.01-1.12). Furthermore, the top 6 reasons why MA and FFS beneficiaries did not receive mammograms were: "not needed," "doctor did not recommend," "forgot," "not recommended annually," "did not like mammograms," and "appointment due soon." Among non-Hispanic blacks and Hispanics specifically, FFS beneficiaries were more likely to report doctors not recommending mammograms than MA beneficiaries. CONCLUSIONS: MA beneficiaries were 1.06 times more likely to receive mammography screening compared with the FFS population. Additionally, providers were less likely to recommend mammographic screening to non-Hispanic black and Hispanic FFS beneficiaries compared with non-Hispanic black and Hispanic MA beneficiaries.

Duke Scholars

Author Anna Hung Population Health Sciences