To identify variations in screening mammography expenditures, primarily out-of-pocket and total expenditures, of women 40–64 years of age in the United States and factors associated with variations.
Methods:
Retrospective analysis of data collected from the 2007 and 2008 Medical Expenditure Panel Survey (MEPS). The sample included 2020 women 40–64 years of age who received one mammogram in 2007 or 2008. Ordinary least squares regression was used to describe relationships among out-of-pocket mammography expenditures, total mammography expenditures, and out-of-pocket mammography expenditures as a percentage of total mammography expenditures and such independent variables as insurance status and type, income, region of the United States, and type of facility where a mammogram was received.
Results:
The average out-of-pocket expenditure for a mammogram in 2007 or 2008 was $33, representing 14.1% of the total mammogram expenditure ($266). After controlling for demographic and health factors, women who were uninsured, were from the Midwest, and had a mammogram at an office-based facility had greater out-of-pocket mammography expenditures. Women who were uninsured, lived in the South, and received their mammogram at an office-based facility had out-of-pocket mammography expenditures that represented a greater proportion of the total mammography expenditures.
Conclusions:
Large variations in out-of-pocket expenditures were observed among women with and without insurance and between insurance types, geographic regions of the United States, and types of facilities where mammograms were received. A higher financial burden of mammography screening among some subgroups of women may act as a barrier to future mammography screening.
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References
1.
U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med, 2009; 151:716–723.
2.
American Cancer Society. How many women get breast cancer? Overview: breast cancer. Atlanta, GA: American Cancer Society, 2010. www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-key-statistics. 2010 September 7.
3.
NelsonH, TyneK, NaikA, BougatosC, ChanB, HumphreyL. Screening for breast cancer: An update for the U.S. Preventive Task Force. Ann Intern Med, 2009; 151:727–737.
4.
BerryD, CroninK, PlevritisSet al.Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med, 2005; 353:1784–1792.
5.
HumphreyL, HelfandM, ChanB, WoolfS. Breast cancer screening: A summary of the evidence for the U.S. Preventive Task Force. Ann Intern Med, 2002; 137:347–360.
6.
McAlearneyA, ReevesK, TatumC, PaskettE. Cost as a barrier to screening mammography among underserved women. Ethnicity Health, 2007; 12:189–203.
7.
PaganJ, AschD, BrownC, GuerraC, ArmstrongK. Lack of community insurance and mammography screening rates among insured and uninsured women. J Clin Oncol, 2008; 26:1865–1870.
8.
CalleE, FlandersD, ThunM, MartinL. Demographic predictors of mammography and Pap smear screening in US women. Am J Public Health, 1993; 83:53–60.
9.
Data2010…The Healthy people 2010 database, January 2010 ed. Focus Area 03–Cancer. CDC wonder. wonder.cdc.gov/data2010/focus.htm. 2010 September 7.
10.
McAlearneyA, ReevesK, TatumC, PaskettE. Perceptions of insurance coverage for screening mammography among women in need of screening. Cancer, 2005; 103:2473–2480.
11.
ZapkaJ, StoddardA, CostanzaM, GreeneH. Breast cancer screening by mammography: Utilization and associated factors. Am J Public Health, 1989; 79:1499–1502.
12.
BreenN, WagenerD, BrownM, DavisW, Ballard-BarbashR. Progress in screening over a decade: Results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst, 2001; 93:1704–1713.
13.
American Cancer Society. Breast cancer facts and figures 2009–2010. Atlanta, GA: American Cancer Society, Inc.
14.
RodriguezM, WardL, Perez-StableE. Breast and cervical cancer screening: Impact of health insurance status, ethnicity, and nativity of Latinas. Ann Fam Med, 2005; 3:235–241.
15.
SolankiG, SchaufflerH. Cost-sharing and the utilization of clinical preventive services. Am J Prev Med, 1999; 17:127–133.
16.
TrivediA, RakowskiW, AyanianJ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med, 2008; 358:375–383.
17.
SolankiG, SchaufflerH, MillerL. The direct and indirect effects of cost-sharing on the use of preventive services. Health Serv Res, 2000; 34:1331–1350.
18.
American Cancer Society. Cancer statistics 2009: A presentation from the American Cancer Society. Atlanta, GA: American Cancer Society, Inc.
19.
LohrK, BrookR, KambergG, GoldbergG, LeibowitzA. Use of medical care in the Rand Health Insurance Experiment: Diagnosis- and service-specific analysis in a randomized controlled trial. Med Care, 1986; 24:51–87.
20.
BreenN, BrownM. The price of mammography in the United States: Data from the National Survey of Mammography Facilities. Milbank Q, 1994; 72:431–450.
21.
ZhangP, TaoG, IrwinK. Utilization of preventive medical services in the United States: A comparison between rural and urban populations. J Rural Health, 2000; 16:349–356.
22.
NystromL, AnderssonI, BjurstamN, FrisellJ, NordenskjoldB, RutqvistL. Long-term effects of mammography screening: Updated overview of the Swedish randomized trials. Lancet, 2002; 359:909–919.
23.
MossS, CuckleH, EvansA, JohnsL, WallerM, BobrowL. Effect of mammography screening from age 40 years on breast cancer mortality at 10 years' follow-up: A randomized controlled trial. Lancet, 2006; 368:2053–2060.
AlexanderF, AndersonT, BrownHet al.14 years of follow-up from the Edinburgh randomized trial of breast-cancer screening. Lancet, 1999; 353:1903–1908.
26.
KerlikowskeK, GradyD, RubinS, SandrockC, ErnsterV. Efficacy of screening mammography: A meta-analysis. JAMA, 1995; 273:149–154.
27.
SunJ, ChapmanJ, GordonR, SivaramakrishnaR, LinkM, FishE. Survival from primary breast cancer after routine clinical use of mammography. Breast, 2002; 8:199–208.
28.
SomkinC, McPheeS, NguyenTet al.The effect of access and satisfaction on regular mammogram and Papanicolaou test screening in a multiethnic population. Med Care, 2004; 42:914–926.
29.
ScanlonW. Medicare hospital and physician payments: Geographic cost adjustments important to preserve beneficiary access to services. United States General Accounting Office. GAO-02-968T. www.gao.gov/new.items/d02968t.pdf. 2010 September 7.
30.
ZapkaJ, StoddardA, MaulL, CostanzaM. Interval adherence to mammography screening guidelines. Med Care, 1991; 29:697–707.
31.
AndersenR. Revisiting the behavioral model and access to medical care: Does it matter?J Health Soc Behav, 1995; 36:1–10.
32.
AndersenR, NewmanJ. Societal and individual determinants of medical care utilization in the United States. Milbank Q, 2005; 83:1–28.
33.
GalbraithA, WongS, KimS, NewacheckP. Out-of-pocket financial burden for low-income families with children: Socioeconomic disparities and effects of insurance. Health Serv Res, 2005; 40:1722–1736.
34.
Medical Expenditure Panel Survey. HC-113: 2007 Full year consolidated data file, November 2009. Agency for Healthcare Research and Quality: Rockville, MDwww.meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h113/h113doc.pdf. 2010 September 7.
35.
Medical Expenditure Panel Survey. Agency for Healthcare Research and Quality: Rockville, MDwww.meps.ahrq.gov/mepsweb/. 2011 January 10.
36.
YuWW, MachlinS. Examination of skewed health expenditure data from the Medical Expenditure Panel Survey (MEPS)Agency for Healthcare Research and Quality Working paper No. 04002, October 2004. www.ahrq.gov. 2011 January 11.
37.
Medical Expenditure Panel Survey. HC sample design and collection process. Agency for Healthcare Research and Quality: Rockville, MDwww.meps.ahrq.gov/survey_comp/hc_data_collection.jsp. 2010 September 7.
38.
Medical Expenditure Panel Survey. HC response rates by panel. Agency for Healthcare Research and Quality: Rockville, MDwww.meps.ahrq.gov/mepsweb/survey_comp/hc_response_rate.jsp. 2011 January 3.
39.
Methodology report 19. Overview of methodology for imputing missing expenditure data in the Medical Expenditure Panel Survey. Agency for Healthcare Research and Quality: Rockville, MDwww.meps.ahrq.gov/mepsweb/data_files/publications/mr19/mr19.pdf. 2010 September 7.
40.
Medical Expenditure Panel Survey. HC-121: 2008 Full year consolidated data file, November 2010. Agency for Healthcare Research and Quality: Rockville, MDwww.meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h121/h121doc.pdf. 2011 January 3.
41.
MachlinS, CohenJ, BeauregardK. Health care expenses for adults with chronic conditions, 2005. Statistical brief 203, 2008. Agency for Healthcare Research and Quality: Rockville, MDwww.meps.ahrq.gov/mepsweb/data_files/publications/st203/stat203.pdf
42.
Consumer Price Index detailed report. tables annual average 2008. Washington, DC: Bureau of Labor Statisticswww.bls.gov/cpi/cpid08av.pdf. 2011 May 2.
43.
SchuelerK, ChuP, Smith-BindmanR. Factors associated with mammography utilization: A systematic quantitative review of the literature. J Womens Health, 2008; 17:1477–1498.
44.
Interim Final Rules for Group Health Plans Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection Affordable Care Act. www.healthcare.gov/center/regulations/prevention/regs.html. 2010 September 7.
