Study Shows Ethnic
Disparities in Medicare Claims for Mammograms
Behind the Cancer Headlines®
African Americans and Latinos are more likely to
underestimate how long it has been since their last routine screening test for
disease – such as a mammogram, Pap smear, or cholesterol test – according to a
"If you ask anyone, ‘When was the last time you had a mammogram, or a cholesterol test?' almost all people will think it's been a shorter time than it's actually been. Over-reporting happens to all of us," said lead author Kevin Fiscella, M.D., M.P.H. "But our study found that some minorities tend to over-report even more often than other groups of patients. This is a problem that has to be recognized and fixed."
Fiscella, an associate professor of Family Medicine and Community and Preventive Medicine at the University of Rochester Medical Center, said he is not sure why the discrepancy in reporting exists. One theory supported by social psychology research is that African-American or Latino patients may feel some pressure to defy stereotypes. So, when doctors or nurses ask them about an event for which they are uncertain, they err on the side of caution and reply affirmatively, he said.
The
With the exception of PSA testing for prostate cancer, results showed that minority patients were more likely to report taking part in a test in the absence of a submitted Medicare claim. In addition to over-reporting errors, the results also might suggest incorrect or inconsistent Medicare billing practices by providers who serve minorities, the study said.
Fiscella said the research, published in the open access journal BMC Health Services Research, has several implications. First, the study shows that ethnic disparities still exist in health care, despite a widespread belief that the gap is closing.
Second, it shows that self-reported data based on patient memory contains too much human error and the federal government should not rely exclusively on it when deciding policy issues, such as the allocation of resources to eliminate health care disparities. Insurance claims may represent a less biased means for national tracking of ethnic disparities.
And perhaps most importantly, the study helps to shed light on vexing questions such as why black women are dying from breast cancer in higher numbers than white women, despite national data suggesting that black women are getting screening mammograms, and therefore have the same access to earlier and better detection as white women.
The authors recommend further studies to clarify the causes
of discrepancies in disparity estimates.
SOURCES:
BMC Health Services
Research,
University of