Abstract
Although numerous studies have established that breast cancer mortality can be significantly reduced through early detection, only a small percentage of women obtain screening mammograms at intervals recommended by the National Cancer Institute, the American Cancer Society, and other major medical organizations. This paper examines the importance of cost as a barrier to routine screening and the state legislative movement to make screening mammography a basic health insurance benefit. Mammography “knowledge, attitudes, and behavior” studies offer conflicting findings on the extent to which cost enters into the decision to have a mammogram. Women seldom report cost as a major reason for postponing or failing to have a mammogram; yet, descriptive studies show a consistently positive relationship between income and mammography use.
State mammography reimbursement laws vary greatly with respect to whether screening mammography is a required or optional benefit, payment limits, and eligibility and referral requirements. Although state-specific data on the percentage of women with private health insurance are not available, 1987 National Medical Expenditure Survey estimates for U.S. Census geographic divisions suggest that the New England, East North Central, West North Central, Middle Atlantic, and Mountain states have the highest percentages of women who are privately-insured and, thus, potentially eligible for legislated mammography benefits. Access to screening mammography also is likely to be influenced by the proportion of employer-sponsored health plans that are self-insured and, therefore, exempt from minimum benefit mandates and the extent to which women are aware of the screening coverage.
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Martha M. McKinney is a Health Services Analyst and Katherine M. Marconi is Associate Director of Science and Epidemiology in the Bureau of Health Resources Development of the Health Resources and Services Administration, Rockville, Maryland. The research on which this paper is based was conducted while Dr. McKinney was a Cancer Prevention Fellow and Dr. Marconi was Chief of the Public Health Applications Research Branch in the National Cancer Institute's Division of Cancer Prevention and Control.
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McKinney, M.M., Marconi, K.M. Legislative interventions to increase access to screening mammography. J Community Health 17, 333–349 (1992). https://doi.org/10.1007/BF01323996
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DOI: https://doi.org/10.1007/BF01323996