Is cost a barrier to screening mammography for low-income women receiving Medicare benefits? A randomized trial

Arch Intern Med. 1994 Jun 13;154(11):1217-24.


Background: 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.

Methods: 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.

Results: 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.

Conclusion: In a low-income, inner-city population of older women, financial barriers to screening mammography persist despite Medicare coverage.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Costs and Cost Analysis
  • Federal Government
  • Female
  • Health Behavior
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility*
  • Humans
  • Mammography / economics*
  • Medicare*
  • Middle Aged
  • Patient Compliance
  • Patient Selection*
  • Poverty*
  • Socioeconomic Factors
  • United States
  • Urban Health