Health insurance and mammography: would a Medicare buy-in take us to universal screening?
OBJECTIVE
To determine whether health insurance expansions via a Medicare buy-in might plausibly increase mammography screening rates among women aged 50-64.


METHODS
Two waves of the Health and Retirement Study (HRS) (1994, 1996).


METHODS
A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996).


METHODS
Our sample included women aged 50-62 in 1994 who answered the second and third HRS interview (n = 4,583).


RESULTS
From 1994 to 1996, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in this age group increased mammography rates only to 75-79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammography, physician visits remained a strong predictor of mammography but BSE did not.


CONCLUSIONS
Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy-in could be expected to have a small impact on mammography screening rates.
Taylor
Donald H
DH
Duke University, Durham, NC 27708, USA.
Van Scoyoc
Lynn
L
Hawley
Sarah Tropman
ST
D016504:Breast Self-Examination / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008327:Mammography / Q000191:economics* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*