title: Does patient cost sharing matter? Its impact on recommended versus controversial cancer screening services.
abstract: OBJECTIVE
  To examine whether there are differential impacts of patient cost sharing and health plan organizational characteristics on the use of a recommended cancer screening service (mammography) versus a controversial cancer screening service (prostate cancer screening [PCS]).
  
  
  METHODS
  Observational cohort using the 1996 Medical Expenditure Panel Survey.
  
  
  METHODS
  A nationally representative sample of privately insured individuals was examined. Outcome measures were the receipt of mammography and PCS. Logistic regression was used to assess the impact of patient cost sharing and health plan organizational characteristics on the receipt of mammography and PCS, controlling for other covariates.
  
  
  RESULTS
  Patient cost sharing and gatekeeper requirements were strong predictors of PCS but were statistically insignificant predictors of mammography. Men in health plans with a copayment over dollar 10 (odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.19-0.78) or with deductibles over dollar 250 (OR = 0.38, 95% CI = 0.23-0.62) were significantly less likely to receive PCS than men in plans with no or lower copayments and deductibles. Men in gatekeeper plans were less likely to receive PCS than those without gatekeepers (OR = 0.48, 95% CI = 0.29-0.81).
  
  
  CONCLUSIONS
  We found the impact of cost sharing on utilization is different between mammography and PCS. Prostate cancer screening utilization appears to respond to financial incentives while mammography utilization does not. The use of copayments, deductibles, and gatekeepers may discourage controversial services but may not have an adverse effect on more recommended services. These findings have implications for the design of insurance benefits and plan organizational structure.
authors.affiliation: University of California, 3333 California St., Suite 420, Box 0613, San Francisco, CA 94143, USA. sliang@itsa.ucsf.edu
authors.forename: Su-Ying
authors.initials: SY
authors.lastname: Liang
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Phillips
authors.forename: Sherilyn
authors.initials: S
authors.lastname: Tye
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.forename: Julie
authors.initials: J
authors.lastname: Sakowski
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D017047:Cost Sharing; D003669:Deductibles and Coinsurance; D003954:Diagnostic Services / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D014481:United States