title: Lessons from state mandates of preventive cancer screenings.
abstract: We use the 1997-2008 Medical Expenditure Panel Survey (MEPS) and variation in the timing of state mandates for coverage of colorectal, cervical, and prostate cancer screenings to investigate the behavioral and financial effects of mandates on privately insured adults. We find that state mandates did not result in increased rates of cancer screening. However, coverage of preventive care, whether mandated or not, moves the cost of care from the consumer's out-of-pocket expense to the premium, resulting in a cross-subsidy of users of the service by non-users. While some cross-subsidies are intentional, others may be unintentional. We find that users of cancer screening have higher levels of income and education, while non-users tend to be racial minorities, lack a usual source of care, and live in communities with fewer physicians per capita. These results suggest that coverage of preventive care may transfer resources from more advantaged individuals to less advantaged individuals.
authors.affiliation: Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA. xu.1636@osu.edu.
authors.forename: Wendy Yi
authors.initials: WY
authors.lastname: Xu
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Dowd
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Abraham
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics; D055088:Early Detection of Cancer / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence; D008297:Male; D018580:Mandatory Testing / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test / Q000191:economics / Q000706:statistics & numerical data; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics; D013219:State Government; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics
chemical_list: D017430:Prostate-Specific Antigen
keywords: Cancer prevention; Health care disparities; Health insurance regulations; Mandated benefits; Redistributive effects