Differences in Rates of Cancer Screening by Usual Source of Medical Care: Data from the 1987 National Health Interview Survey

Abstract

Data from the Cancer Control Supplement of the 1987 Health Interview Survey (NHIS), a nationally representative sample of the United States population, was used to examine rates of six screening tests for cancer. The rates of screening were compared for people who receive their usual source of medical care in an HMO or prepaid group practice versus those who receive it in the fee-for-service sector. The purpose of this article is to determine whether HMOs remain more likely to offer cancer screening examinations than the fee-for-service sector. Results indicate that for five of six screening tests examined (Pap smear, mammography, breast physical examination, digital rectal examination, and blood stool test), members of HMOs are significantly more likely to have received the test within the last 3-year period. These results hold in a multivariate analysis when many factors correlated with selection into HMOs, health status, and use of medical services are controlled for, although results are only generalizable to whites. Future research should focus on why the rates for five of the six cancer screening tests examined are higher in HMO settings, and how we can use the HMO experience to improve consensus as to the usefulness of the tests in the non-HMO physician pool, and ultimately increase rates of screening tests in the non-HMO population.