title: Mandated coverage of preventive care and reduction in disparities: evidence from colorectal cancer screening.
abstract: OBJECTIVE
  We identified correlates of racial/ethnic disparities in colorectal cancer screening and changes in disparities under state-mandated insurance coverage.
  
  
  METHODS
  Using Behavioral Risk Factor Surveillance System data, we estimated a Fairlie decomposition in the insured population aged 50 to 64 years and a regression-adjusted difference-in-difference-in-difference model of changes in screening attributable to mandates.
  
  
  RESULTS
  Under mandated coverage, blood stool test (BST) rates increased among Black, Asian, and Native American men, but rates among Whites also increased, so disparities did not change. Endoscopic screening rates increased by 10 percentage points for Hispanic men and 3 percentage points for non-Hispanic men. BST rates fell among Hispanic relative to non-Hispanic men. We found no changes for women. However, endoscopic screening rates improved among lower income individuals across all races and ethnicities.
  
  
  CONCLUSIONS
  Mandates were associated with a reduction in endoscopic screening disparities only for Hispanic men but may indirectly reduce racial/ethnic disparities by increasing rates among lower income individuals. Findings imply that systematic differences in insurance coverage, or health plan fragmentation, likely existed without mandates. These findings underscore the need to research disparities within insured populations.
authors.affiliation: Mary K. Hamman is with the Department of Economics, College of Business Administration, University of Wisconsin-La Crosse. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hamman
authors.forename: Kandice A
authors.initials: KA
authors.lastname: Kapinos
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States