title: The impact of Medicaid coverage and reimbursement on access to diagnostic mammography.
abstract: BACKGROUND
  Women of low socioeconomic status are at risk for delayed evaluation of abnormal mammograms and later stage presentations of breast cancer. Medicaid reimbursement for clinical services is lower than Medicare reimbursement, yet it is unclear whether low Medicaid reimbursement is a barrier to accessing mammography. The objective of the current study was to determine the association between reported insurance type (Medicaid vs Medicare), Medicaid reimbursement rate, and access to diagnostic mammography (DM).
  
  
  METHODS
  Standardized patients (SPs) called 521 mammography facilities in defined geographic regions of 11 states in 2005. Facilities were divided between high, middle, and low reimbursing states based on the state's relative Medicaid-to-Medicare reimbursement rate for DM. SPs contacted each facility twice to schedule a DM using the same clinical vignette but switching insurance status (Medicaid vs Medicare). The authors measured the proportion of SPs who were offered 1) any appointment and 2) a timely appointment, defined as a third available appointment within 20 business days.
  
  
  RESULTS
  SPs with Medicaid were less likely to receive an appointment than SPs with Medicare (91% vs 99.1%; difference, 8.1%; 95% confidence interval, 5.3%-10.9% [P < .001]). Among facilities that offered appointments to both callers, the proportion of timely appointments did not differ between Medicaid (93.7%) and Medicare (92.9%; P = .51). States' Medicaid reimbursement rates for DM were not associated with the percentage of SPs with Medicaid who were offered any appointment (P = .50) or a timely appointment (P = .69).
  
  
  CONCLUSIONS
  Callers with Medicaid were offered appointments for DM less frequently than callers with Medicare, although both were widely accepted. State Medicaid reimbursement rates did not affect access to mammography.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Veterans Affairs Medical Center, West Haven, Connecticut, USA. jschuur@partners.org
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
authors.forename: Akash
authors.initials: A
authors.lastname: Shah
authors.forename: Zheyang
authors.initials: Z
authors.lastname: Wu
authors.forename: Howard P
authors.initials: HP
authors.lastname: Forman
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D001071:Appointments and Schedules; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D019458:Insurance Coverage; D007349:Insurance, Health, Reimbursement; D008327:Mammography / Q000191:economics*; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D013997:Time Factors; D014481:United States