Day 28- Medicaid at 50: Pap smears

As has been alluded to before on this blog, there has been significant controversy about how to measure quality in the Medicaid program as compared to uninsurance and private coverage. Some studies show that Medicaid beneficiaries are more likely to die, but these studies might not control for health status. Low income individuals often have lower health status (see social determinants of health) and study results have to control for this since Medicaid serves low income individuals. Some studies say that they control for health status, however it is important to look at their measures, because questions like “have you ever been diagnosed with XX disease” would be artificially low for uninsured people. Uninsured people haven’t had normal sources of care and therefore are less likely to have been diagnosed with a disease even if they actually have the disease.

In short, measuring quality for Medicaid beneficiaries is very hard.

This interesting paper controls for an individual’s health insurance selection in addition to health status. Taking this into account they find that many measures of access and use are much higher for Medicaid beneficiaries than uninsured individuals. Additionally, they find that access is about equal to private coverage. This could be in part because people aren’t aware that they are Medicaid beneficiaries.

But as the title of this post suggests- I want to talk about pap smears. Here is what the paper says:

In contrast, uninsured mothers are significantly more likely to lack a usual source of care and to have unmet need and less likely to have a doctor visit, dental visit, pap smear, or clinical breast exam than Medicaid mothers.

But that’s not all! When states expand family planning services, women Medicaid beneficiaries are more likely to receive pap smears. This Robert Wood Johnson study looked more closely at the issue and found:

Scholar Laura Wherry, PhD (2012-2014), analyzed health survey data from states with and without expanded Medicaid family planning programs between 1993 and 2009, and examined changes in the services that eligible women used. Her study found that “expansions in Medicaid family planning services increased screenings for breast and cervical cancer among low-income women and narrowed the gap in the utilization of these services when compared with higher income women.”

So, next time someone tells you that Medicaid doesn’t give people access to health care, remind them that women are people too.


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