title: Laws requiring health plans to provide direct access to obstetricians and gynecologists, and use of cancer screening by women.
abstract: BACKGROUND
  Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter "ob/gyns") for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no literature has examined the relationship between ob/gyn direct access laws and use of breast cancer and cervical cancer screening.
  
  
  METHODS
  We use repeated cross-sections of privately insured women age 18-64 (Pap test) and 40-64 (mammography) from the Behavioral Risk Factor Surveillance System for 1996-2000, linked to data on the presence of ob/gyn direct access laws by state. Outcome measures are receipt of mammography and receipt of a Pap test within the past 2 years. Regression analyses are used to assess the relationship between the presence of ob/gyn direct access laws and screening, adjusting for a range of individual characteristics, fixed state characteristics, and time trends.
  
  
  RESULTS
  We find no statistically significant relationships between the presence of an ob/gyn direct access law and receipt of either mammography or Pap test screening. We explore a range of alternate specifications and find none that yield clear evidence of a relationship.
  
  
  CONCLUSIONS
  Laws requiring direct access to ob/gyns are not associated with large or consistent measurable impacts on use of cancer screening.
authors.affiliation: Department of Health Research and Policy, Stanford University, Center for Health Policy, Stanford University, National Bureau of Economic Research, Stanford University, Stanford, CA 94305-5405, USA.
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Baker
authors.forename: Jia
authors.initials: J
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D005260:Female; D033161:Government Regulation; D006176:Gynecology / Q000331:legislation & jurisprudence*; D015438:Health Behavior; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D008403:Mass Screening; D008875:Middle Aged; D009774:Obstetrics / Q000331:legislation & jurisprudence*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014481:United States; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014932:Women's Health Services / Q000331:legislation & jurisprudence* / Q000600:supply & distribution