Health Care Costs and Financing

High managed care penetration boosts breast and cervical cancer screening, with spillover effects to non-managed care patients

Timely breast cancer screening via mammography and clinical breast exam and cervical cancer screening via Pap smears is greater in areas with greater health maintenance organization (HMO) market share, according to a new study. Breast and cervical cancer screening rates increased with area HMO market share. After accounting for individual and area characteristics, women in high HMO market share areas were nearly twice as likely to have recently received a mammogram or Pap smear and were 58 percent more likely to have had a recent clinical breast exam than women in areas with low managed care penetration. For prostate cancer screening, which is not universally recommended, the relationship between screening rates and HMO market share was non-significant and inconsistent.

Managed care penetration also seemed to have a spillover effect on cancer screening practices for patients not enrolled in managed care plans. Indeed, increasing HMO market share tended to improve screening rates even more in the non-managed care group than in the managed care group. This effect was significant for clinical breast exam and Pap smear and marginally significant for mammography screening in high HMO market share areas.

The study was led by Laurence Baker, Ph.D., of Stanford University School of Medicine, and supported in part by the Agency for Healthcare Research and Quality (HS10771, HS10856, and HS10925). The researchers linked data on cancer screening from the 1996 Medical Expenditure Panel Survey to data on HMO market share and HMO competition in metropolitan statistical areas. They examined the relationship between area managed care prevalence and use of the four types of cancer screening during the previous 2 years.

More details are in "The effect of area HMO market share on cancer screening," by Dr. Baker, Kathryn A. Phillips, Ph.D., Jennifer S. Haas, M.D., M.S.P.H., and others, in the December 2004 Health Services Research 39(6), Part I, pp. 1751-1772.

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