Supply and quality of screening mammography: a radiologist's view

Article Abstract:

The costs of medical care and services in the US are increasing, and may also be inadequately distributed. For example, screening mammography, X-ray of the breast, is not widely performed because of the high costs of this procedure. However, if more women were examined by mammography, there would be a decrease in the costs of this screening service and an increase in its availability, without effecting the quality and accuracy of this diagnostic procedure. One study showed that the oversupply of mammography machines increases the cost per mammogram because the number of women utilizing each machine decreases. The machines are sold to anyone, with no regard for their qualifications to operate them. Screening may be performed by primary care physicians in their practices for convenience, increased likelihood of patient compliance, lower costs, and probably for reasons of profit. Although the American College of Radiology offers an accreditation process to establish quality assurance certifications for screening mammography, less than 20 percent of mammography units in the United States have been accredited. Standard terms and methods of reporting, including the use of a computer software program, have been developed to improve the accuracy of interpreting and reporting mammograms. Less than 30 percent of women who require routine mammography have actually been screened, mainly due to a lack of communication between patients and their physicians. Women claim that they are not informed about the need for a mammogram, whereas physicians claim that patients are reluctant to undergo the procedure. Studies show that screening mammography and physical examination of the breast can reduce death from breast cancer. Recommendations for establishing screening programs are described. However, the costs, quality assurance, and accurate interpretation of results from screening mammography must be considered when providing this medical service. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Oversupply of screening mammography units: why should internists care?

Article Abstract:

In an efficient free enterprise system, the supply should be balanced with the demand for goods and services. Because medical care is not paid directly by patients, but by third parties, patients are less concerned about costs and less informed about the need for services. The physician is actually the main consumer and control over the supply of medical services is lacking. More medical care may not necessarily lead to better care, which is demonstrated by the mammography screening, the X-ray examination of the breast for the presence of cancer. One study showed that the supply of mammography units is much greater than the number required to screen women for breast cancer. Although the American College of Physicians recommends that mammography screening should focus on women over 50 years of age, other professional organizations suggest that screening should be started earlier and be performed more frequently. It was estimated that the supply of mammography units exceeds the demand for these services by 50 percent. This imbalance has an economic effect on the entire medical community. The cost of a screening mammogram will tend to be higher than it should be to pay for the costs of these underutilized units. In addition, the oversupply may stimulate an increased use of available services by younger women who have a low prevalence, leading to an increased frequency of false-positive results. This may result in additional costs from more frequent breast biopsies. Thus, more medical care may not result in more cost-effective or better medical care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical screening, Health screening

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Is the supply of mammography machines outstripping need and demand?

Article Abstract:

Although the effectiveness of screening mammography, the X-ray examination of the breast, has been demonstrated, this service is not used frequently. The high cost of mammography may discourage its use. The necessary equipment, facilities, technologists, and radiologists must be available for mammography to be properly performed. However, an excess in the supply of these services ultimately results in inefficient use of these health care resources. There has been an explosive increase in the number of machines used to perform mammography. Almost 10,000 mammography machines will be installed by 1990, whereas the demand for screening mammography will require only 2,600 machines. This imbalance between supply and demand of mammography machines poses several economic problems. First, the excess of mammography machines is inefficient. Second, the low usage of mammography equipment will result in an increase in the price of the test, from about $50 to $100, to cover the costs. This increased cost may further deter screening. Third, quality assurance and medical record keeping may be adversely affected by the excessive supply of mammography machines. The support of an excessive number of mammography machines is impractical and probably not sustainable over time. (Consumer Summary produced by Reliance Medical Information, Inc.)

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