Treatment Lags for Many on Medicare, Study Finds

Many Medicare beneficiaries are not getting the treatment they should be receiving, such as regular mammograms for breast cancer survivors and annual vision tests for diabetics, according to a study by the Rand Corp. in Santa Monica and the Veterans Affairs Department.

The study did not examine the reasons for the gaps in care. But Dr. Steven Asch of the West Los Angeles VA Hospital, who led the study, said the possibilities include poorer-quality physicians, patients’ inability or unwillingness to follow doctors’ instructions and discrimination by doctors.

Asch said the findings suggest that inadequate care contributed in some cases to worse outcomes. For example, blacks were hospitalized more often for congestive heart failure than whites, perhaps because they had poorer treatment or preventive care or less access to care, he said.

The study, reported in today’s Journal of the American Medical Assn., looked at 345,253 Medicare patients 65 and older.

Fewer than two-thirds received care for 14 out of 37 generally recommended procedures, including preventive care, diagnostic tests and hospitalization, the researchers reported.

Fewer than two-thirds of white breast cancer patients, who run a high risk of another cancer, received annual follow-up mammograms. Fewer than half of diabetics, who are prone to eye problems, received annual vision tests. The lapses occurred even though the treatments were covered by Medicare.

Blacks, poor people and those living in rural areas were especially likely to be under-treated, said the researchers from the Rand Corp.

The findings follow a state-by-state Medicare study that the journal published last month, which found widespread geographical disparities in care.

The researchers examined Medicare claims data from 1994 to 1996, but Asch said a lack of adequate care among beneficiaries remains a problem.