Minority Gap in Medical Screening Tests Persists

Review of Medicare claims shows patient surveys aren't providing accurate data

FRIDAY, Sept. 29, 2006 (HealthDay News) -- While recent patient surveys have suggested that Americans of all backgrounds are getting important disease-screening tests, a new review of Medicare claims refutes that view.

The study finds that minorities are getting potentially lifesaving tests much less often than whites.

"If you ask the question, 'How big is the gap in preventive services between minorities and whites?,' the answer differs depending on whether you rely on peoples' self-reports of what they got vs. actual medical claims," said lead researcher Dr. Kevin Fiscella, an associate professor of family medicine and community and preventive medicine at the University of Rochester School of Medicine and Dentistry.

According to Fiscella, if experts and policymakers "just rely on self-report, you might erroneously conclude that there is very little gap or none at all," he said. "If you actually look at the claims data, you see there really is a gap and disparities are really persisting."

Why these gaps continue to exist is unclear, but the new findings might influence the allocation of resources aimed at eliminating race-based gaps in health care disparities, the researchers said.

The report appears in the Sept. 28 online issue of the open-access journal BMC Health Services Research.

In the study, Fiscella's team looked at patient surveys of standard recommended screening tests and then compared those figures with data from Medicare claims.

The researchers looked at a total of nearly 50,000 such records. Procedures included PSA testing for prostate cancer; Pap smear testing for precancerous and cancerous cervical lesions, cholesterol tests, mammography screening for breast cancer, and colorectal cancer screening tests. In addition, the team also looked at flu vaccinations.

They found that, with the exception of PSA testing, ethnic disparities in preventive procedures were larger when based on Medicare claims than when using patients' self-reports. Minorities were more likely than whites to have reported that they had undergone a particular procedure -- even though no relevant Medicare claim was made.

This ethnic-based discrepancies ranged from 2.4 percent for cholesterol testing to 17.9 percent for influenza vaccination, based on patient self-reports. However, when the researchers looked at Medicare claims, the gap rose from 5.1 percent for cholesterol testing to 19.9 percent for flu vaccination.

Fiscella speculates that many people, especially minorities, either don't want to admit to surveyors that they didn't receive a particular test, or they don't remember how long ago it is they actually got tested.

The bottom line, however, is that a reliance on patients' self-reports could lead policymakers to believe that a disparity in health care is being eliminated, when in fact it is not.

"We can't just rely on self-report," Fiscella said. "We have to look at other sources of data before we jump to conclusions and celebrate prematurely that we have narrowed or even closed the gap in a particular area."

Fiscella believes doctors need better systems to track the tests patients have had and to keep track of those they still need. In addition, outreach programs that identify people who need screening tests can help eliminate these disparities, he said.

One expert agreed that patient education is key.

"This study really demonstrates how much work really needs to be done in consumer health education," said Robert M. Hayes, president of the New York City-based Medicare Rights Center. "The real job is to get consumers to understand the importance of preventive care," he added.

Hayes believes more outreach could ensure that Medicare recipients get the screening tests they need. "The disparity between self reporting and claims reflects patients not appreciating the importance of the care, or the meaning of the question," he said. "Patients need an immense amount of health care education and need to have it repeated regularly and clearly," he said.

More information

For current recommendations on cancer screening, head to the American Cancer Society.

SOURCES: Kevin Fiscella, M.D., M.P.H., associate professor, family medicine and community and preventive medicine, University of Rochester School of Medicine and Dentistry, New York; Robert M. Hayes, president, Medicare Rights Center, New York City; Sept. 28, 2006, BMC Health Services Research online
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