JAMA study: Medicare coverage boosts cancer, cholesterol screening for previously uninsured adults

August 12, 2003

New York City, August 12, 2003--Gaining access to Medicare coverage substantially improved uninsured older adults' use of clinical preventive measures such as cholesterol testing, mammography, and prostate exams, compared with a similar group of insured adults, according to a new study in the August 13 issue of the Journal of the American Medical Association (JAMA).

"Many older uninsured Americans have great difficulty finding affordable health insurance coverage, or even any coverage at all," said Karen Davis, president of The Commonwealth Fund, which supported the study. "An early Medicare buy-in option for these adults would ensure greater access to potentially life-saving preventive tests, which makes sense both medically and economically."

Prior to Medicare eligibility, only 41 percent of uninsured adults examined in the study received cholesterol testing, compared with 76 percent of insured adults--a difference of 35 percentage points --according to the article, "Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults," by J. Michael McWilliams, M.D., Alan M. Zaslavsky, Ph.D., Ellen Meara, Ph.D., and John Z. Ayanian, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston. Meanwhile, 46 percent of uninsured adults received mammograms, versus 76 percent of insured adults (a 30 percentage point difference). For prostate cancer screening, the disparity was even greater: 29 percent of the uninsured were given this test, compared with 74 percent of the insured (a 45 percentage point difference).

Once uninsured adults became eligible for Medicare coverage, the differences in preventive testing rates between the two groups were dramatically reduced. Differences in cholesterol testing rates between previously uninsured and insured patients fell from 35 percentage points before Medicare eligibility to 18 percentage points after Medicare eligibility; differences in mammography testing rates dropped from 30 percentage points to 15 percentage points; and differences in prostate cancer screening rates fell from 45 percentage points to 20 percentage points.

With one exception, the results did not differ for uninsured adults by sex, race/ethnicity, income, employment status, or presence of diabetes or hypertension. For cholesterol testing, the gap between the continuously uninsured and the insured groups was reduced significantly more among those with hypertension or diabetes, from 37 percentage points to 8 percentage points (a 29 percentage point difference), than among adults without either condition, who experienced a drop of only 8 percentage points. Patients with hypertension or diabetes face an increased risk of heart disease or stroke, so they are most likely to benefit from cholesterol testing and treatment.

"The marked increases in the use of mammography and cholesterol testing show distinct benefits for previously uninsured adults who gain Medicare coverage," said Dr. Ayanian, one of the authors of the study and a researcher at Harvard Medical School. "Extending Medicare coverage to these adults before age 65 has the potential to save many lives through prevention or earlier detection and treatment of major medical conditions such as cancer or heart disease."
The Commonwealth Fund is a private foundation supporting independent research on health and social issues. To read or download publications, visit our website at www.cmwf.org.

Commonwealth Fund

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.