Medicaid: do differing state reimbursement policies affect cancer screening?


Medicaid: do differing state reimbursement policies affect cancer screening?

A recent study investigating the impact of state-specific differences in Medicaid provision has found that screening rates for breast, cervical and colorectal cancer could be affected by certain state-specific reimbursement and eligibility policies.

The Medicaid health insurance program for particular low-income individuals funds the medical care of a large proportion of the US population. In 2010, it was estimated that 67.7 million US citizens received health care provision due to Medicaid, and this figure is expected to rise following the passing of the Patient Protection and Affordable Care Act.

Although Medicaid programs across the US provide access to breast, cervical and colorectal cancer screening, there is no guarantee that these services will be fully utilized.

Evidence from previous studies suggests that Medicaid users were less likely to receive cancer screening than individuals with private health insurance, and they were more likely to present themselves with advanced stages of cancer than individuals with private health insurance or Medicare provision.

Although federal government sets the limits for Medicaid, within these parameters states get to set their own eligibility requirements and reimbursements. Due to this freedom, there are substantial differences in Medicaid provision among different states and districts.

State-specific differences

Medicaid beneficiaries in states providing higher rates of reimbursement for office visits were found to be more likely to receive recommended cancer screening.

"Few studies have examined how state-specific differences in Medicaid policies might affect use of preventive care services, particularly for early detection of cancer," said Dr. Michael Halpern, one of the authors of the study.

"Our study was able to compare differences in cancer screening for Medicaid beneficiaries in almost all states, providing a broad, national picture of the effects of state-level Medicaid policies on receipt of these critical medical care services among a large group of underserved individuals."

The study, published in Cancer, was funded by the Centers for Disease Control and Prevention (CDC).

Dr. Halpern and his colleagues analyzed the 2007 Medicaid data from 46 states and Washington DC, examining associations between state-specific policies and the receipt of screening tests such as pap tests, colonoscopy, mammography and fecal occult blood testing.

The researchers discovered that, within states providing higher Medicaid reimbursements for office visits, people benefiting from Medicaid were more likely to receive recommended screening for breast, cervical and colorectal cancer.

There was not always an association, however, with higher payments for the screening tests and increased receipt of screening among Medicaid beneficiaries. Also, Medicaid beneficiaries in states that used an "asset test" as part of determining eligibility were less likely to receive cancer screening.

Changing Medicaid policies

Although the data used in the study did not differentiate between initial cancer screenings and follow-up testing, the authors write that the majority of tests examined will have been for screenings. They argue that screening is much more common than follow-up testing, and cancer patients were excluded from the current study.

The link between an increased likelihood of receiving cancer screening and higher reimbursements for office visits could suggest that there are barriers in accessing primary care physicians for Medicaid beneficiaries in states that have lower rates of reimbursement.

Although raising reimbursement for the screening tests may expand the facilities that provide these services, the study suggests that increasing payments for office visits is what could increase access to and the supply of providers that order screening tests.

Equally, eliminating asset testing for eligibility may improve the likelihood of individuals with low-income receiving cancer screenings, and thus potentially increasing the rate of detecting cancers at earlier stages.

Dr. Halpin believes their findings could prove beneficial to policy-makers:

Due to multiple factors, including Health Care Reform and decreased state budgets, many states are changing their Medicaid policies, including how much health care providers are paid and who is allowed to enroll. Our findings can help state health care decision makers and policy leaders to develop new Medicaid policies that aid low-income individuals in receiving recommended cancer screenings."

The study provides convincing suggestions for how policies can be used to tackle barriers to accessing health care and improve the uptake of vital cancer screening services.

Recently, Medical-Diag.com, reported on a study that examined how health care reform in the shape of Obamacare could affect rates of inpatient surgery.

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