Financial Barriers to Mammography: Who Pays Out-of-Pocket?
ABSTRACT This study investigates how out-of-pocket payments for mammograms vary according to the characteristics of women and the states where they reside.
We conducted a cross-sectional analysis for women >or=40 years using data from the 2000 National Health Interview Survey (NHIS) Cancer Control Module linked with state characteristics. Descriptive tabulations and logistic regressions were used to examine characteristics associated with out-of-pocket payment for a woman's most recent mammogram for the subset of approximately 7000 women reporting a mammogram within the past 2 years.
In 2000, the majority of women who received a mammogram within the past 2 years paid no out-of-pocket costs: 68% among those aged 40-64 and 85% among those aged >or=66. Among women aged 40-64 with a recent mammogram, characteristics associated with paying out-of-pocket for the last mammogram were white, non-Hispanic race/ethnicity, being uninsured, having non-HMO private coverage, place of residence outside the Northeast, in a non-metropolitan county, and in a state with low HMO penetration.
Public insurance and HMO coverage have been especially effective in eliminating financial barriers to mammography, but women 40-64 years with public coverage still lag behind their privately insured counterparts in using mammography. Out-of-pocket costs remain a barrier to use for uninsured women. Older women, although less likely than younger women to pay out-of-pocket for mammograms, remain less likely to use mammography than younger women.
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- "Those without sick leave who take work time off for preventive services may lose pay. High deductibles and other forms of cost sharing have been associated with underuse of preventive services [28,29], specifically colorectal cancer screening  and mammography [31,32]. Lack of paid sick leave appears to be a potential barrier to obtaining needed medical care and a societal benefit that is potentially amenable to change. "
ABSTRACT: Preventive health care services, such as cancer screening can be particularly vulnerable to a lack of paid leave from work since care is not being sought for illness or symptoms. We first describe the prevalence of paid sick leave by broad occupational categories and then examine the association between access to paid sick leave and cancer testing and medical care-seeking in the U.S. workforce. Data from the 2008 National Health Interview survey were analyzed by using paid sick leave status and other health-related factors to describe the proportion of U.S. workers undergoing mammography, Pap testing, endoscopy, fecal occult blood test (FOBT), and medical-care seeking. More than 48 million individuals (38%) in an estimated U.S. working population of 127 million did not have paid sick leave in 2008. The percentage of workers who underwent mammography, Pap test, endoscopy at recommended intervals, had seen a doctor during the previous 12 months or had at least one visit to a health care provider during the previous 12 months was significantly higher among those with paid sick leave compared with those without sick leave after controlling for sociodemographic and health-care-related factors. Lack of paid sick leave appears to be a potential barrier to obtaining preventive medical care and is a societal benefit that is potentially amenable to change.BMC Public Health 07/2012; 12(1):520. DOI:10.1186/1471-2458-12-520 · 2.26 Impact Factor
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ABSTRACT: This paper examines the rates of recent mammography use among African American and White women, the influence of demographic characteristics, socioeconomic status, health insurance coverage, and breast cancer risk factors on recent mammography use and reasons for not having a mammogram. Cross-sectional data from the Southern Community Cohort Study were used to analyze mammography use among African American and White women. Among 27,123 mostly low-income women age 42-79 in the Southern Community Cohort Study, the rate of recent (within the past 2 years) mammography use was 73% among African Americans and 68% among Whites. Health insurance coverage, age, household income, education, family history of breast cancer, hormone replacement therapy use, and post-menopausal status were positively associated with recent mammography, whereas consumption of 2 or more alcoholic drinks/day was negatively associated. These associations were observed in both African American and White women who had never [corrected] received a mammogram (Non-users) compared with recent mammography users, although some variation existed [corrected] Doctor has not recommended this test and cost were the two most commonly self-reported reasons for non-use. Characteristics of non-users and past users identified may provide valuable information for maintaining the progress made and for further improving adherence to the screening guidelines.Journal of Health Care for the Poor and Underserved 12/2007; 18(4 Suppl):102-17. DOI:10.1353/hpu.2007.0115 · 1.10 Impact Factor
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ABSTRACT: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) covers the direct clinical costs of breast and cervical cancer screening and diagnostic follow-up for medically underserved, low-income women. Personal costs are not covered. In this report, the authors estimated personal costs per woman participating in NBCCEDP mammography screening by race/ethnicity and also estimated lifetime personal costs (ages 50-74 years). A decision analysis model was constructed and parameterized by using empiric data from a retrospective cohort survey of mammography rescreening among women ages 50 years to 64 years who participated in the NBCCEDP. Data from 1870 women were collected from 1999 to 2000. The model simulated the flow of resources incurred by a woman participating in the NBCCEDP. The analysis was stratified by annual income into 2 scenarios: Scenario 1, <$10,000; and Scenario 2, from $10,000 to <$20,000. Sensitivity analyses were conducted to appraise uncertainty, and all costs were standardized to 2000 U.S. dollars. In Scenario 1, for all races/ethnicities, a woman incurred a 1-time cost of $17 and a discounted lifetime cost of $108 for 10 screens and $262 for 25 screens; in Scenario 2, these amounts were $31 and from $197 to $475, respectively. In both scenarios, a non-Hispanic white woman incurred the highest cost. The sensitivity analyses revealed that >70% of cost incurred was attributable to opportunity cost. Capturing and quantifying personal costs will help ascertain the total cost (ie, societal cost) of providing mammography screening to a medically underserved, low-income woman participating in a publicly funded cancer screening program and, thus, will help determine the true cost-effectiveness of such programs.Cancer 08/2008; 113(3):592-601. DOI:10.1002/cncr.23613 · 4.89 Impact Factor