Many on Medicare Not Getting Tests

      CHICAGO (AP) - 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, a study found.

      It was not clear from the study whether the fault lies with the patients or with their doctors.

      The study, reported in Wednesday''s Journal of the American Medical Association, 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 undertreated, said the researchers, from the Rand Corp. think tank in Santa Monica, Calif., and the Veterans Affairs Department.

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

      Edward L. Hannan, a State University of New York health policy expert, said in an accompanying editorial that the Rand study underlines ``a compelling need to engage in painstaking studies of how treatment decisions are made.''

      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 researchers examined Medicare claims data from 1994-96, but Asch said a lack of adequate care among beneficiaries remains a problem.

      On the Net:

      JAMA: http://jama.ama-assn.org

      Health Care Finance Administration: http://www.hcfa.gov

     

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