Mandated coverage of preventive care and reduction in disparities: Evidence from colorectal cancer screening

M.K. Hamman and K.A. Kapinos

American Journal of Public Health, 2015, vol. 105, S508-S516

Abstract: Objectives. 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.

Keywords: aged; colonoscopy; Colorectal Neoplasms; early diagnosis; ethnology; female; health care disparity; human; insurance; male; mass screening; middle aged; socioeconomics; statistics and numerical data; United States, Aged; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Healthcare Disparities; Humans; Insurance Coverage; Male; Mass Screening; Middle Aged; Socioeconomic Factors; United States (search for similar items in EconPapers)
Date: 2015
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2015.302578_3

DOI: 10.2105/AJPH.2015.302578

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