Access to Mammography Is Still a Problem

WASHINGTON--The number of women over age 40 who have ever hada mammography has risen significantly in the past few decades,P. Ellen Parsons, MPH, PhD, said at the spring meeting of theNational Mammography Quality Assurance Advisory Committee.

The figures still need improvement, however, and improving accessto mammography remains an important issue. According to the 1992CDC Health Interview Survey, 69% of white women over 40 and 58%of black women over 40 had ever had a mammogram, and of all womenaged 50 to 64, only half had had a mammogram in the past year,she said.

Dr. Parsons is a survey statistician in the Division of HealthInterview Statistics at the National Center for Health Statistics,Centers for Disease Control and Prevention.

As might be expected, women with private health insurance aremore likely to seek mammography than those on Medicare/Medicaid,or with no health insurance, she said. Because they have betteraccess to routine screening programs, women who belong to an HMOobtain mammograms more frequently than women in fee-for-serviceplans.

Dr. Parsons described four major areas that influence access tocare:

Characteristics of the health-care delivery system, includingthe number and type of hospitals and physicians in a given geographicalarea and the time it takes people to reach a delivery site.

Characteristics of the population at risk, such as age, sex, race,cultural background, education, and socioeconomic status.

Utilization of health services, including the stage of healthor illness at which people enter the system, the type of servicesthey receive, and where those services are performed, ie, communityhospital or tertiary care facility.

Consumer satisfaction with convenience, courtesy, cost, qualityof care, and the way test results are provided.