title: Health care reform in Oregon: the impact of the Oregon Health Plan on utilization of mammography.
abstract: BACKGROUND
  In 1994, Oregon implemented the Oregon Health Plan (OHP), extending health care coverage under a system of capitated managed care to uninsured citizens living below the Federal Poverty Level (FPL). We conducted a study to measure receipt of clinical preventive services among women newly enrolled in the OHP.
  
  
  METHODS
  Six hundred and sixty six women aged 52-64, and living below the FPL in Oregon were randomly selected from OHP enrollment rosters and interviewed by telephone. A follow-up survey was conducted 1 year later. The main outcome of interest was receipt of a screening mammogram during the first year in the OHP.
  
  
  RESULTS
  At enrollment 17% (65/383) of participants had never had health care coverage. Sixty-six percent of the women (220/333) were overdue for a mammogram. Fifty-five percent (121/220) reported cost as the main reason they had not had this procedure. Mammography rates doubled under the OHP (21% to 52%, 95% CI = 0.25-0.38, p < 0.001). Among women who were overdue for a mammogram at the time they enrolled, an expressed plan to get a mammogram (OR3.0, 95% CI = 1.1-8.7, p = 0.04), citing cost as the main reason for being overdue (OR3.0, 95% CI = 1.3-7.2, p = 0.014), receipt of a routine checkup (OR9.5, 95%CI = 3.7-24.9, p < 0.001), and health care provider's (HCP's) recommendation for mammography (OR8.1,95% CI = 2.9-23.0, p < 0.001) were independently associated with receipt of a mammogram.
  
  
  CONCLUSIONS
  The OHP enrolled and successfully delivered clinical preventive services to a medically under served population. Even after removing the financial barrier, obstacles to mammography remain. These may be overcome by health systems changes to insure receipt of routine checkups and appropriate provider recommendations.
authors.affiliation: Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. jus8@cdc.gov
authors.forename: J A
authors.initials: JA
authors.lastname: Schillinger
authors.forename: C
authors.initials: C
authors.lastname: Mosbaek
authors.forename: D
authors.initials: D
authors.lastname: Austin
authors.forename: L
authors.initials: L
authors.lastname: Jack
authors.forename: M
authors.initials: M
authors.lastname: Heumann
authors.forename: J
authors.initials: J
authors.lastname: Moore
authors.forename: J
authors.initials: J
authors.lastname: Bussman
authors.forename: J
authors.initials: J
authors.lastname: Van Osdal
authors.forename: D W
authors.initials: DW
authors.lastname: Fleming
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008329:Managed Care Programs; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009922:Oregon; D011203:Poverty; D011314:Preventive Health Services / Q000706:statistics & numerical data; D013221:State Health Plans; D014481:United States