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Disparities in use of preventive care may be reduced by requiring Medicare HMO enrollees to select a primary care doctor

Some Medicare+Choice health maintenance organizations (HMOs) have been successful in reducing socioeconomic disparities in the use of preventive services by elderly men. The findings of a study by Leo S. Morales, M.D., Ph.D., of RAND Health and the University of California, Los Angeles, and his colleagues raise the possibility that requiring enrollees to select a primary care provider (PCP) may lessen socioeconomic disparities in use of preventive services. Mandatory enrollment with a PCP may foster a regular patient-provider relationship which, in turn, may promote use of preventive services, especially among low-income people.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS09630), Dr. Morales and his colleagues examined the effects of demographic and socioeconomic factors on use of three preventive care services—prostate-specific antigen (PSA) testing, colorectal cancer (CRC) screening, and influenza vaccination—among elderly men enrolled in two Medicare HMOs.

Overall, 49 percent of the men underwent PSA testing, 32 percent underwent CRC screening, and 49 percent received an influenza vaccination. Age, marital status, educational attainment, and household wealth were all associated with the use of one or more of the preventive services studied. However, plan-specific analyses revealed income-related differences in PSA testing, CRC screening, and number of preventive services used in the Midwestern plan, which did not require enrollees to choose a PCP, but not in the Northeastern plan, which did include this requirement.

Other studies have found much lower influenza vaccination rates among blacks compared with whites, but this study found no racial difference in vaccination rates after adjusting for other factors. On the other hand, there was a 14 percent difference in influenza vaccination rates between men with less than a high school education and men with some college, and an 11 percent difference between men in the lowest and highest wealth categories.

See "Use of preventive services by men enrolled in Medicare+Choice plans," by Leo S. Morales, M.D., Ph.D., Jeannette Rogowski, Ph.D., Vicki A. Freedman, Ph.D., and others, in the May 2004 American Journal of Public Health 94(5), pp. 796-802.

Editor's Note: Another AHRQ-supported study on a related topic found that office systems that support vaccination for pneumonia, such as patient and provider reminders and express vaccination clinics, might improve pneumonia vaccination rates. For more details, see Santibanez, T.A., Zimmerman, R.K., Nowalk, M.P., and others (2004, January). "Physician attitudes and beliefs associated with patient pneumococcal polysaccharide vaccination status." (AHRQ grant HS09874). Annals of Family Medicine 2(1), pp. 41-48.

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