Medicare

Only nine percent of fee-for-service Medicare beneficiaries age 50 or older receive recommended annual fecal occult blood testing for colorectal cancer. About two percent receive sigmoidoscopy testing. Women use colorectal cancer screening and diagnostic services slightly more than men, whites somewhat more than African Americans, Asians, and Hispanics. Enrollees in managed care plans are at least as likely to use these services as fee-for-service Medicare beneficiaries. Key among the reasons for the low use of screening and diagnostic services are poor patient awareness of recommendations and coverage for screening, physicians' reluctance to perform the procedures because of their time and complexity, and the lack of monitoring systems to encourage their use. GAO concludes that there is room for better outreach and education. GAO finds that efforts are under way to enhance public awareness of the risks of colorectal cancer and the benefits of screening.

GAO noted that: (1) the use of colorectal cancer screening and diagnostic services by Medicare beneficiaries is very low relative to recommended use rates and has remained almost unchanged over the past 5 years; (2) although guidelines recommend annual fecal occult blood testing for all people aged 50 and older, only 9 percent of fee-for-service beneficiaries received that test each year; (3) use rates for flexible sigmoidoscopy are significantly lower and have also remained constant at about 2 percent of beneficiaries; (4) women's use of some colorectal cancer screening and diagnostic services was slightly higher than men's, and white beneficiaries received the services at somewhat higher rates than African Americans, Asians, and Hispanics; (5) although use data are not available for Medicare beneficiaries in health maintenance organizations, research suggests that enrollees in managed care plans are at least as likely to have colorectal cancer screening as those in fee-for-service Medicare; (6) various factors contribute to the low use of screening and diagnostic services, some of which are beginning to be addressed by public health agencies and private organizations; and (7) key among these is poor patient awareness of recommendations and coverage for screening, physician reluctance to perform the procedures because of the time and complexity involved, and lack of monitoring systems to encourage greater use.