Differences in the frequency of cholesterol screening in patients with Medicaid compared with private insurance

To assess compliance with preventive screening for Medicaid recipients compared with individuals with equal access to preventive services.

A community-based family practice residency program.

Survey of a consecutive sample of English-reading individuals, aged 18 to 50 years, with Medicaid (n = 98) or private insurance (n = 75), who had scheduled appointments in the clinic.

Patients with Medicaid were as likely as those with private insurance to be screened for hypertension and cervical cancer in the last 5 years but were less likely to have received cholesterol screening (39% vs 65%, P < .001). Even after adjusting for differences in gender composition, age, race, marital status, and education level attained, patients with Medicaid were still less likely to have received cholesterol screening (odds ratio, 0.43; 95% confidence interval, 0.21 to 0.57). Although patients with Medicaid were no more likely to identify a barrier and, when identifying barriers, did not identify significantly more barriers than patients with private insurance, Medicaid recipients were less likely to state that cholesterol testing had been recommended by their physician (30% vs 44%, P = .05).

Because access to screening tests by patients with Medicaid is equal to or better than that of those with insurance, differences in the frequency of cholesterol screening should not reflect financial barriers. Differences in the attention paid to screening by physicians and differences in cultural beliefs about the importance of screening may play a role in the underuse of screening services by individuals in lower socioeconomic groups.