Association between health insurance coverage of office visit and cancer screening among women

Med Care. 2002 Nov;40(11):1060-7. doi: 10.1097/00005650-200211000-00007.


Background: Little is known regarding the nuances of insurance benefit design that may affect the receipt of clinical preventive services.

Objective: To evaluate whether differences in insurance coverage of physician office visits influences the receipt of cancer screening in women who have full coverage for the screening services.

Design: Cohort study of women enrolled in fee-for-service (FFS) or Preferred Provider Organization (PPO) health plans, where FFS plans have less generous office visit coverage, for the period 1995 to 1997.

Settings and participants: General Motors Corporation's employees and their dependents.

Main outcome measures: Papanicolaou and mammography rates in women aged 21 to 64 years (n = 139,294) and 52 to 64 years (n = 56,554), respectively.

Results: Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain a Papanicolaou smear and mammogram (adjusted relative risk [RRa] = 1.22; 95% CI, 1.21-1.24; and RRa, 1.17; 95% CI, 1.15-1.18, respectively). The association was more pronounced among hourly individuals (RRa, 1.27; 95% CI, 1.26-1.29 for Papanicolaou smears; RRa, 1.17; 95% CI, 1.16-1.19 for mammograms) than among salaried individuals (RRa, 1.10; 95% CI, 1.08-1.12 for Papanicolaou smears and RRa, 1.10; 95% CI, 1.06-1.12 for mammograms), corresponding to a greater differential in office visit coverage among the hourly group.

Conclusions: Benefit structure appears to have an important effect on receipt of cancer screening in women. The findings highlight the need to ensure that future reforms of the health care system do not adversely affect the use of preventive services.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Breast Neoplasms / diagnosis*
  • Fee-for-Service Plans
  • Female
  • Humans
  • Insurance Coverage*
  • Insurance, Physician Services*
  • Mammography / economics
  • Mammography / statistics & numerical data
  • Mass Screening / economics
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Office Visits / economics*
  • Papanicolaou Test
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Preferred Provider Organizations
  • Preventive Health Services / economics
  • Preventive Health Services / statistics & numerical data*
  • Statistics as Topic
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears / statistics & numerical data