Abstract
Variation in utilization of healthcare services is influenced by patient, provider and healthcare system characteristics. It could also be related to the evidence supporting their use, as reflected in the availability and strength of recommendations in clinical guidelines. In this study, we analyzed the geographic variation of colorectal, breast and prostate cancer screening utilization in Switzerland and the influence of available guidelines and different modifiers of access. Colonoscopy, mammography and prostate specific antigen (PSA) testing use in eligible population in 2014 was assessed with administrative claims data. We ran a multilevel multivariable logistic regression model and calculated Moran’s I and regional level median odds ratio (MOR) statistics to explore residual geographic variation. In total, an estimated 8.1% of eligible persons received colonoscopy, 22.3% mammography and 31.3% PSA testing. Low deductibles, supplementary health insurance and enrollment in a managed care plan were associated with higher screening utilization. Cantonal breast cancer screening programs were also associated with higher utilization. Spatial clustering was observed in the raw regional utilization of all services, but only for prostate cancer screening in regional residuals of the multilevel model. MOR was highest for prostate cancer screening (1.24) and lowest for colorectal cancer screening (1.16). The reasons for the variation of the prostate cancer screening utilization, not recommended routinely without explicit shared decision-making, could be further investigated by adding provider characteristics and patient preference information. This first cross-comparison of different cancer screening patterns indicates that the strength of recommendations, mediated by specific health policies facilitating screening, may indeed contribute to variation.
Highlights
The reporting of the marginal effects in multilevel model would have been limited, we present the effects from multivariable logistic regression models with the same covariates
The proportions of persons with urban residence, supplementary insurance, managed care, and a high deductible level were similar among persons receiving each cancer screening services, as was the number of Pharmaceutical cost group (PCG) present
Cantons with organized breast cancer screening programs were associated with more breast cancer screening, whereas the effect of language was inconsistent across the services
Summary
Provider and healthcare system characteristics may influence access to healthcare and can be defined in terms of personal, financial and organizational barriers and facilitators [1]. Breast and prostate cancer screening activity in Switzerland possibilities of the research proposal and decide to grant access if the research questions can be answered with the use of the Helsana data. Data are accessible only in a secure environment. The authors did not have any special access to this data that others would not have
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