When signed into law in 1965, Medicare was envisioned as a safety net to protect seniors from catastrophic financial loss following acute illness or hospitalization.1 At that time, medical care for older adults consisted predominately of illness care,2 and preventive care was not viewed as an essential component of the Medicare program. Indeed, the Medicare statute explicitly excluded coverage of preventive services.3 Although recent legislation (the Medicare Improvements for Patients and Providers Act [MIPPA] of 2008) empowered the Centers for Medicare and Medicaid Services (CMS) to add Medicare coverage for preventive services under specific conditions,4 addition of Medicare coverage for preventive services previously required Congressional action.3 This requirement made it possible for nonscientific interests to influence coverage policy.
Prevalence of computer-aided detection (CAD) use, 2001 to 2003. Error bars denote 95% confidence intervals.
Percentage of screening mammograms that were interpreted with computer-aided detection (CAD) by Surveillance, Epidemiology, and End Results (SEER) region, 2003, adjusted for patient age, race and ethnicity, median household income (of elderly householders residing within same zip code as patient), and rural vs urban residence. Error bars denote 95% confidence interval.
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