Mandated Coverage of Preventive Care and Reduction in Disparities: Evidence From Colorectal Cancer Screening
| Autor: | Kandice A. Kapinos, Mary K. Hamman |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
Research and Practice education Population Ethnic group Insurance Coverage Preventive care fluids and secretions Environmental health parasitic diseases Humans Mass Screening Medicine Healthcare Disparities Early Detection of Cancer Aged education.field_of_study Behavioral Risk Factor Surveillance System business.industry Native american Public Health Environmental and Occupational Health Cancer Colonoscopy Middle Aged medicine.disease United States Health equity body regions Socioeconomic Factors Colorectal cancer screening Female sense organs Colorectal Neoplasms business |
| Zdroj: | American Journal of Public Health. 105:S508-S516 |
| ISSN: | 1541-0048 0090-0036 |
| DOI: | 10.2105/ajph.2015.302578 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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