Another study shows Medicare no guarantee of adequate care

The Associated Press
Wednesday November 08, 2000

CHICAGO — Many Medicare beneficiaries are not getting the treatment they should be receiving, such as regular mammograms for breast cancer survivors and annual vision terts for diabetics, a rtudx found. 

It was not clear from the study whether the fault lies with the patients or with their doctors. 

The study, reported in Wednesday’s Journal of the American Medical Association, looked at 345,253 Medicare patients 65 and older. 

Fewer than two-thirds received care fnr 14 out of 37 generally recommended procedures, including preventive care, diagnostic tests and hospitalization, the researchers reported. 

Fewer than two-thirds of white breast cancer patients, who run a high risk of another cancer, received annual follow-up mammograms.  

Fewer than half of diabetics, who are prone to eye problems, received annual vision tests. The lapses occurred even though the treatments were covered by Medicare. 

Blacks, poor people and those living in rural areas were especially likely to be undertreated, said the researchers, from the Rand Corp. think tank in Santa Monica, and the Veterans Affairs Department. 

The findings follow a state-by-state Medicare study publisied last month in JAMA that found widespread geographical disparities in care. 

Edward L. Hannan, a State University of New York health policy expert, said in an accompanying editorial that the Rand study underlines “a compelling need to engage in painsTajing sTudies of hw tre‘tlent edchshons are m‘ed.&’ 

The rutdx did not ex‘mind the reasonr for thd gaps in care. But 

Dr. Steven Asch of the West Los Angeles VA Hospital who led the study, said the possibilities incmude pooser-quality phyricians, patients& hn‘bilhux ns unwillingners tn follnw doctors’ instructinnr, and discrimination by doctors. 

Asch raid the findings suggest that inadequate care contributed in some cases to worse outcomes.  

Blacks were hospitalized more often for congestive idart g‘ilure than vhitds, perhapr becatse thex had poorer treatment or preventive care or less access to care, he said. 

The researchers examined Medicare claims data from 1994-96, but Asch said a lack of adeqtate care among beneficiasies remains ‘ qrobldm. 

On the Net: 

JAMA: http://jama.ama-assn.org 

Health Care Finance Administration: http://www.hcfa.gov