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June 13, 1994

Is Cost a Barrier to Screening Mammography for Low-Income Women Receiving Medicare Benefits?A Randomized Trial

Author Affiliations

From the Department of Medicine, Center for Ethics, Medicine and Public Issues, Baylor College of Medicine, Ben Taub General Hospital, Houston, Tex.

Arch Intern Med. 1994;154(11):1217-1224. doi:10.1001/archinte.1994.00420110059007

Background:  In 1991, Medicare began covering screening mammograms subject to copayment and deductible. This study evaluated the effectiveness of Medicare in removing financial barriers to screening mammography among low-income older women.

Methods:  In an inner-city public hospital's General Medicine Clinic, 119 consecutive, eligible, and consenting Medicare-enrolled women without known risk factors for breast cancer other than age, and no mammogram in the previous 2 years, were entered into a randomized controlled trial with follow-up after 2 months. The mean age was 71 years; 77% were black, 92% had an annual income below $10 000, and 52% had had a previous mammogram. All patients were counseled concerning indications for screening mammograms and Medicare coverage, and all were referred to a low-cost mammography facility. Sixty-one subjects were randomly assigned a voucher for a free screening mammogram at the referral facility. Obtaining a mammogram within 60 days of study entry was the main outcome measure.

Results:  Of the women given vouchers, 27 (44%) obtained screening mammograms, compared with six (10%) of those without vouchers (P<.001). Adjustment by multiple logistic regression confirmed this association, yielding an adjusted odds ratio of 7.4 (95% confidence interval, 2.5 to 21.4). Knowledge concerning mammography and breast cancer increased significantly overall (and within randomization groups) between initial interview and follow-up; fear did not change. For women without the voucher, the main reason for not obtaining a mammogram was financial; the main reason for women with the voucher was transportation.

Conclusion:  In a low-income, inner-city population of older women, financial barriers to screening mammography persist despite Medicare coverage.(Arch Intern Med. 1994;154:1217-1224)

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