Study: Doctors Order Fewer Preventive Services for Medicaid Patients

Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found.

The study by researchers at the Urban Institute examined how office-based primary care practices provided five recommended preventive services over a five-year period. The services were clinical breast exams, pelvic exams, mammograms, Pap tests and depression screening.

The study used data from the National Ambulatory Medical Care Survey, a federal health database of services provided by physicians in office-based settings. It looked at 12,444 visits to primary care practitioners by privately insured women and 1,519 visits by women who were covered by Medicaid between 2006 and 2010. That difference reflects the fact that the share of women who are privately insured is seven times larger than those on Medicaid, the researchers said. Pregnancy-related visits and visits to clinics were excluded from the analysis.

Overall, 26 percent of the visits by women with Medicaid included at least one of the five services, compared with 31 percent of the visits by privately insured women.

As for specific preventive services, the study found “strong evidence” that visits by Medicaid patients were less likely include a clinical breast exam or a Pap test, says Stacey McMorrow, a senior research associate at the Urban Institute’s Health Policy Center and the study’s lead author. The differences for depression screening weren’t statistically significant, and once patient characteristics such as age, race and home address were taken into account weren’t significant for mammograms or pelvic exams either.

For example, 20.5 percent of visits by privately insured women included a clinical breast exam, and 16.5 percent of visits included a Pap test. But the percentage of Medicaid-insured visits that included those services was only 12 percent and 9.5 percent, respectively. (The differences narrowed but remained statistically significant when adjusted for patient characteristics.)

The Medicaid-insured women were not necessarily receiving lower quality care, according to the study. They may have been receiving additional care at a community health clinic or from a nurse practitioner, for example, but the study only examined physician services provided in office-based practices.

In addition, privately insured women may have been receiving services more frequently than recommended. For example, current guidelines generally recommend a Pap test to screen for cervical cancer every three years. But if a patient asks for a Pap test every year the doctor may provide it, McMorrow says.

In addition, private insurers generally pay providers better than does Medicaid, sometimes significantly better, she says: “Where providers are getting reimbursed better, they’re going to provide services more frequently.”

Kaiser Health News (KHN) is a nonprofit national health policy news service.