Macro-level factors impacting geographic disparities in cancer screening.

Lee R Mobley,Victoria Udalova,Tzy-Mey Kuo,Jeffrey Traczynski,He Frech

doi:10.1186/s13561-014-0013-7

Abstract

ObjectivesExamine how differences in state regulatory environments predict geographic disparities in the utilization of cancer screening.Data sources/setting100% Medicare fee-for-service population data from 2001-2005 was developed as multi-year breast (BC) and colorectal cancer (CRC) screening utilization rates in each county in the US.Study designA comprehensive set of supply and demand predictors are used in a multilevel model of county-level cancer screening utilization in the context of state regulatory markets. States dictate insurance mandates/regulations and whether alternative providers (nurse practitioners) can provide preventive care services supplied by MDs. Controlling statistically for the supply of both types of providers, we study the joint effects of two private insurance regulations: one mandating that insureds with serious or chronic health conditions may receive continuity of care from their established physician(s) after changing health insurance plans, and another mandating that external grievance review is an option for all health plan coverage/denial decisions. These private insurance plan regulations are expected to affect the degree of beneficial spillovers from managed care practices, which may have increased area-wide cancer screening rates.Principal findingsThe two private insurance regulations under study were significant predictors impacted by local market conditions. Managed care spillovers in local markets were significantly associated with higher BC screening rates, but only in states lacking the two forms of regulation under study. Spillovers were significantly associated with higher CRC cancer screening rates everywhere, but much higher in the unregulated states. Area poverty dampened screening rates, but less so for CRC screening in the states with these regulations.ConclusionsTwo state insurance regulations that empowered consumers with more autonomy to make informed utilization decisions varied across states, and exhibited significant associations with screening rates, which varied with the degree of managed care penetration or poverty in the state’s counties. Beneficial spillover effects from managed care practices and negative influences from area poverty are not uniform across the United States. Both variables had stronger associations with CRC than BC screening utilization, as did state regulatory variables. CRC screening by endoscopy was more subject to market and regulatory factors than BC screening.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0013-7) contains supplementary material, which is available to authorized users.

Highlights

In the United States in 2009, breast cancer (BC) was the most common cancer in women and colorectal cancer (CRC) was the third most common cancer in both men and women [1]
Two state insurance regulations that empowered consumers with more autonomy to make informed utilization decisions varied across states, and exhibited significant associations with screening rates, which varied with the degree of managed care penetration or poverty in the state’s counties
CRC screening by endoscopy was more subject to market and regulatory factors than BC screening

Summary

Introduction

In the United States in 2009, breast cancer (BC) was the most common cancer in women and colorectal cancer (CRC) was the third most common cancer in both men and women [1] Today, these facts persist and one in four deaths in the United States is attributable to Numerous previous studies have examined impacts of personal and environmental factors on the utilization of cancer screening, but no studies have examined whether macro-level factors, such as the states’ insurance regulatory environments, have had an impact on cancer screening utilization. We expect this correlation to be stronger for CRC than for BC screening utilization, because the former is more susceptible to influence from economic factors and consumer information that can be impacted by the regulatory environment

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