Kiefe C I, McKay S V, Halevy A, Brody B A
Department of Medicine, Baylor College of Medicine, Ben Taub General Hospital, Houston, Tex.
Arch Intern Med. 1994 Jun 13;154(11):1217-24.
In 1991, Medicare began covering screening mammograms subject to copayment and deductible. This study evaluated the effectiveness of Medicare in removing financial barriers to screening mammography among low-income older women.
In an inner-city public hospital's General Medicine Clinic, 119 consecutive, eligible, and consenting Medicare-enrolled women without known risk factors for breast cancer other than age, and no mammogram in the previous 2 years, were entered into a randomized controlled trial with follow-up after 2 months. The mean age was 71 years; 77% were black, 92% had an annual income below $10,000, and 52% had had a previous mammogram. All patients were counseled concerning indications for screening mammograms and Medicare coverage, and all were referred to a low-cost mammography facility. Sixty-one subjects were randomly assigned a voucher for a free screening mammogram at the referral facility. Obtaining a mammogram within 60 days of study entry was the main outcome measure.
Of the women given vouchers, 27 (44%) obtained screening mammograms, compared with six (10%) of those without vouchers (P < .001). Adjustment by multiple logistic regression confirmed this association, yielding an adjusted odds ratio of 7.4 (95% confidence interval, 2.5 to 21.4). Knowledge concerning mammography and breast cancer increased significantly overall (and within randomization groups) between initial interview and follow-up; fear did not change. For women without the voucher, the main reason for not obtaining a mammogram was financial; the main reason for women with the voucher was transportation.
In a low-income, inner-city population of older women, financial barriers to screening mammography persist despite Medicare coverage.
1991年，医疗保险开始承保需自付一定费用和扣除免赔额的乳腺钼靶筛查。本研究评估了医疗保险在消除低收入老年女性进行乳腺钼靶筛查的经济障碍方面的有效性。
在一家市中心公立医院的普通内科门诊，119名连续、符合条件且同意参与的参保医疗保险女性被纳入一项随机对照试验，这些女性除年龄外无已知乳腺癌风险因素，且在过去2年未进行过乳腺钼靶检查，试验在2个月后进行随访。平均年龄为71岁；77%为黑人，92%年收入低于10,000美元，52%曾进行过乳腺钼靶检查。所有患者均接受了关于乳腺钼靶筛查指征和医疗保险覆盖范围的咨询，并全部被转介至一家低成本的乳腺钼靶检查机构。61名受试者被随机分配一张在转介机构进行免费乳腺钼靶筛查的代金券。在研究入组后60天内进行乳腺钼靶检查是主要结局指标。
获得代金券的女性中，27名（44%）进行了乳腺钼靶筛查，而未获得代金券的女性中只有6名（10%）进行了筛查（P <.001）。通过多因素逻辑回归调整证实了这种关联，调整后的优势比为7.4（95%置信区间，2.5至21.4）。从初次访谈至随访，总体上（以及在随机分组内）关于乳腺钼靶检查和乳腺癌的知识显著增加；恐惧情绪未改变。对于未获得代金券的女性，未进行乳腺钼靶检查的主要原因是经济因素；对于获得代金券的女性，主要原因是交通问题。
在低收入的市中心老年女性人群中，尽管有医疗保险覆盖，但乳腺钼靶筛查的经济障碍依然存在。
