title: Effects of an extended free-of-fee strategy on the rate of cervical Papanicolaou smear screening in Israel.
abstract: OBJECTIVE
  To investigate the influence of an extended free-of-fee strategy on the rate of cervical Papanicolaou (Pap) smear screening in Israel.
  
  
  METHODS
  A retrospective analysis was conducted of data obtained from a computer-generated list of women aged 15-74 years who attended appointments with Clalit Health Services between January 1, 2008, and November 30, 2011, during which Pap smears were taken. The basic strategy allowed a no-fee Pap smear once every 3 years between the ages of 35 and 54 years; the extended strategy allowed a no-fee Pap smear once every 3 years between the ages of 25 and 54 years.
  
  
  RESULTS
  In all, 65 565 Pap smears were taken. The mean monthly study population was 161 438 women. The mean monthly Pap smear rate for the basic strategy was 0.64% ± 0.5% (95% confidence interval [CI], 0.59-0.68) versus 0.75% ± 0.6% (95% CI, 0.70-0.79) for the extended strategy (P=0.004). Age group (P<0.001), Pap smear strategy type (P<0.001), and combined age group and strategy type (P=0.028) each predicted the monthly rate of Pap smear screening in a univariate analysis.
  
  
  CONCLUSIONS
  Implementation of the extended free-of-fee strategy increased the rate of Pap smear screening among Israeli women.
authors.affiliation: Clalit Health Services, Southern District, Israel.
authors.forename: Miron
authors.initials: M
authors.lastname: Froimovici
authors.forename: Vicky
authors.initials: V
authors.lastname: Sulema
authors.forename: Samuel
authors.initials: S
authors.lastname: Lurie
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005249:Fees and Charges; D005260:Female; D006801:Humans; D007557:Israel; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult