In a recent study of Medicare recipient patients by the Dartmouth Atlas project, headed by Prof. Elliott Fisher at the New Hampshire college, analysis showed that in 2004 and 2005 only 57% of African-American women age sixty-five to sixty-nine got mammograms, whereas 64% of white women got the recommended breast cancer screening. Mammography rates were also shown to vary by state in those years amongst those covered by Medicare. For example, while Maine’s mammography rate for the above demographic was 74%, Mississippi’s was only 56.9%. Another important indicator of this trend was shown in the rates at which diabetic Medicare patients age sixty-five to seventy-four in the years 2003 through 2005 sought tests of their hemoglobin A1C levels. Vermont’s average annual rate of the tests was 91.5%, a number significantly higher than Alaskans’ rate of 70.9%. In 2003 and 2005 African-American patients lost legs as a result of advanced diabetes and vascular disease at a rate of 4.17 per 1000 Medicare beneficiaries, while the rate for whites was only 0.88.
The fact that all study subjects had similar federal insurance coverage to help pay for these important medical needs, the data being drawn from the Medicare program, begs the question: why are those in some states and African-Americans overall less likely to seek certain crucial tests? The Dartmouth professor advising the Atlas project commented on multiple contributing factors to these disparities, including differences in local healthcare practices and resources as well as patient engagement in their own treatment.
In order to alleviate this disparity and encourage Medicare recipients to proactively seek these tests, the Robert Wood Johnson Foundation has invested $300 million in local groups in regions such as Detroit, Cincinnati, and Memphis to “boost efforts to measure doctors’ performance, teach patients, and involved more players in [grantees] quality initiatives” as well as to “pay for work by nurses aimed at improving performance on measures such as the handling of patients when they are discharged from a hospital.” But will these initiatives perpetuate change on these issues of disparity after the funding is spent? Only if communities embrace the importance of health literacy and increase education on the importance of preventative care and ongoing treatment to quell fears about such tests and other important Medicare-covered procedures.
Recently, the Star-Ledger of New Jersey reported on important health insurance issues coming to vote in the Senate. The latest issue with health insurance in New Jersey seeks to grant access to more that 175,000 uninsured people across New Jersey. The new bill will expand the eligibility for the New Jersey FamilyCare program. The bill will give a family of four, access to the plan if they earn less than $42,000 per year. This is an increase of $14,000 from the previous bill. The plan is estimated to cost about $29 million in the first year of coverage. The Democratic Party representing the state seeks to offer access to health insurance for those who cannot afford it. With New Jersey’s sky-high rates, it’s easy to understand how health insurance is unattainable for a family of four with a low level of income.
Objection comes from many who currently purchase their own New Jersey Health Insurance. Of the 88,000 individuals, they are largely concerned with how the new costs will affect the costs and access of their healthcare. In recent years, it hasn’t been uncommon for health insurers to increase their rates by 20%. This has become an increasingly unbearable cost as yearly salaries are only increasing by about 10%.
The proposed Bill, if signed, will become effective in 2010 but will be voted on this summer. By then, hopefully we will have some information to understand how this program will be paid for. Until then I will remain skeptical on the success of the plan.