July 7, 2015 — Primary care physicians ordered fewer preventive health care services for women who had Medicaid coverage than they did for women who were privately insured, according to a recent study by the Urban Institute, Kaiser Health News reports.
For the study, researchers examined the rate at which office-based primary care providers delivered five recommended preventive health care services between 2006 and 2010. The preventive services included clinical breast exams, depression screening, mammograms, Pap tests and pelvic exams.
The researchers assessed information from the National Ambulatory Medical Care Survey, which included data on services provided during 12,444 office visits with primary care providers by women with private health plans and 1,519 visits by women with Medicaid coverage. The researchers did not include visits related to pregnancy or clinic visits.
Overall, the researchers found 26% of visits by women insured by Medicaid included at least one of the preventive health services. By contrast, 31% of visits by women with private health plans included at least one of the services.
The study found "strong evidence" that visits by Medicaid beneficiaries were not as likely as those by privately insured women to include clinical breast exams or Pap tests. According to the study, 20.5% of visits by women with private coverage included clinical breast exams, while 16.5% of such visits included Pap tests. In comparison, 12% of visits by women with Medicaid coverage included clinical breast exams, while 9.5% included Pap tests.
Meanwhile, the researchers did not find any statistically significant differences for depression screening between the privately insured women and those with Medicaid coverage. Similarly, there were no statistically significant differences for pelvic exams or mammograms once certain patient characteristics were considered, including address, age and race.
The researchers noted that, despite the discrepancies, women covered by Medicaid might not be receiving lower quality health care. For example, the study noted that women covered by Medicaid might receive health care services at community health clinics or from nurse practitioners, which were not included in the analysis.
The study also noted that women with private health plans might have received some of the preventive services more frequently than necessary. For example, the American College of Obstetricians and Gynecologists recommends women receive Pap tests every three years, but some patients might receive the tests annually (Andrews, Kaiser Health News, 7/2).