Cervical cancer screening in elderly women

Article Abstract:

Starting in July 1990, Medicare will pay for the Pap smear test when used as a screening procedure for cervical cancer. While Medicare has always covered Pap smears in diagnosing women with symptoms of disease, the program has not previously paid for the Pap smear as a screening test in asymptomatic women. This year the Pap smear will become one of very few preventive health services that are covered by Medicare. The decision was based in part on a report by the Congressional Office of Technology Assessment, which investigated the potential impact on the health of older women and on health care costs. Approximately one in four new cases of cervical cancer are found in women aged 65 or older, yet few screening programs have been developed that focus on this age group. Many elderly women have never had a Pap smear, even though the test has been in use for 30 years. Of women who have had a Pap smear, almost 50 percent have not had one in the past three years. Women at greatest risk for cervical cancer are those who are poor, nonwhite, or smokers, those who first had sexual intercourse at a young age, and those that had multiple partners. The cost analysis indicated that while paying for Pap smear screening among elderly women would not save health care costs overall, the cost is not very high given the potential years of life saved. The predicted health care costs and lives saved are discussed for various screening schedules, including a single screening at age 65, and screening every three years starting at age 65; the latter plan was chosen for Medicare coverage. Costs will be reduced if the diagnostic accuracy of the Pap smear test is improved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Economic aspects, Reports, Economic policy, Demographic aspects, Cervical cancer, Aged women, Preventive health services, Elderly women, Preventive medicine, Medicare, Pap test, United States. Office of Technology Assessment, Geriatric gynecology

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Emergency medical care and the public purse

Article Abstract:

Local governments have an important role to play to maintain adequate emergency and trauma services. Some hospitals have closed their emergency departments and trauma centers because of lack of funding. The Los Angeles County-University of Southern California trauma system has been hit hard by a drop in tax revenues in California since the passage of Proposition 13 in 1977. The rise of managed care in other parts of the country has the same effect because they impose cost-containment procedures that cut into hospitals' profits. The profits would have been used to cover uncompensated care.

Finance, Emergency medical services, Trauma centers

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