Socioeconomic Differences in Use of Low‐Value Cancer Screenings and Distributional Effects in Medicare
研究了美国联邦医保按服务付费模式下，社会经济地位较高者更可能使用低价值癌症筛查，并从非使用者和纳税人处获得更多补贴。
OBJECTIVE: Consuming low-value health care not only highlights inefficient resource use but also brings an important concern regarding the economics of disparities. We identify the relation of socioeconomic characteristics to the use of low-value cancer screenings in Medicare fee-for-service (FFS) settings, and quantify the amount subsidized from nonusers and taxpayers to users of these screenings. DATA SOURCES: 2007-2013 Medicare Current Beneficiary Survey, Medicare FFS claims, and the Area Health Resource Files. STUDY DESIGN: Our sample included enrollees in FFS Part B for the entire calendar year. We excluded beneficiaries with a claims-documented or self-reported history of targeted cancers, or those enrolled in Medicaid or Medicare Advantage plans. We identified use of low-value Pap smears, mammograms, and prostate-specific antigen tests based on established algorithms, and estimated a logistic model with year dummies separately for each test. DATA COLLECTION/EXTRACTION METHODS: Secondary data analyses. PRINCIPAL FINDINGS: We found a statistically significant positive association between privileged socioeconomic characteristics and use of low-value screenings. Having higher income and supplemental private insurance strongly predicted more net subsidies from Medicare. CONCLUSIONS: FFS enrollees who are better off in terms of sociodemographic characteristics receive greater subsidies from taxpayers for using low-value cancer screenings.