PCN183 - Effects of the Primary Payer Type and Race/Ethnicity on Prostate Cancer Screening Practices During Preventive Health Exams in United States Ambulatory Care Settings

Abstract

There is limited information on the relationship between insurance coverage and prostate cancer(PCa)-screening practices among race/ethnic minorities in ambulatory care settings in the US. The objective of this study was to determine whether the observed race/ethnicity differences in prostate-specific antigen(PSA)-screening for PCa may be explained by differences in insurance coverage. We analyzed a nationally representative sample of visits to office-based physicians’ practices from 2005-2010 using the National Ambulatory Medical Care Survey (NAMCS). The sample consisted of outpatient visits for preventive health exams (PHEs) of men aged 40 years and above, without PCa. The primary insurance payer categories were mutually exclusive and included the following: Medicare, Medicaid, private insurance and other types. Information on the receipt of PSA-screening, demographics, physician specialty and type of office setting were collected. Generalized estimating equations were used to investigate the effect of race and insurance type on PSA-screening. Application of the inclusion criteria resulted in 5,829 office-visits for PHEs. Majority (57%) of the sample was aged below 66 years, 10% were African Americans and 9% Hispanics. Over 47% were covered by private insurance, 39% by Medicare and 5% Medicaid. Overall, 16% received PSA-screening during a PHE. Hispanics (prevalence ratio:0.62,95%CI:0.43-0.90) and Medicaid (prevalence ratio:0.24, 95%CI:0.11-0.55) patients were less likely to receive PSA-screening compared to Whites and patients with private insurance. PHEs conducted in health maintenance organizations were more likely to have a PSA-screening, compared to physician group settings. General practitioners were more likely to receive PSA-screening compared to other types of specialists. Interactions between race and insurance type were not significant. Hispanics and individuals insured by Medicaid are less likely to receive PSA-screening during an ambulatory care office-visit for a PHE. Efforts to improve access to cancer-screening services are warranted for these groups. It is necessary to consider the differential impact of PCa-screening policies on medically underserved populations.