Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates

Abstract

Cervical cancer is one of the most preventable, treatable, and survivable cancers. Relative to screenings for breast, colon, or prostate cancer, screenings for cervical cancer (Pap tests) are more commonly used, cheaper, and do not require use of expensive imaging equipment or supplementary visits to health care providers to be administered. We provide the literature's first evidence on the effects of 24 state mandates adopted from 1988 to 2000 that require insurance plans to cover Pap tests. In standard difference-in-differences models using data on 600,000 women age 19-64 from the CDC's Behavioral Risk Factor Surveillance System, we find that these mandates significantly increased past 2-year and lifetime Pap test use rates by 1.4 and 0.8 and percentage points, respectively (about 2 and 1 percent). These effects are plausibly concentrated among insured women and are not observed for other women's health outcomes (e.g., mammograms). Effects are particularly large, positive, and robust for Hispanic women. Our results suggest that mandating more generous insurance coverage for even cheap, routine services with already high utilization rates can significantly further increase utilization.