Provision Of Free Services Research Articles

The Effective Coverage of Maternal and Child Primary Health-Care-Services and its Relationship with Health-Expenditures: An Analysis at Sub-National-Level in Iran

Introduction: The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran.
 Methods: This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita.
 Results: At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas.
 Conclusion: This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran.

ДОПОМОГА МІЖНАРОДНИХ ТА НАЦІОНАЛЬНИХ ФОНДІВ, ОРГАНІЗАЦІЙ МІСЦЕВИМ ГРОМАДАМ

Since February 24, 2022, that is, since the beginning of the large-scale invasion of the Russian Federation on the territory of Ukraine, there has been an urgent need to provide humanitarian aid to both the military and the civilian population, including internally displaced persons. Citizens of Ukraine rallied to help Ukraine: public organizations, charitable foundations, volunteers, ordinary citizens and the international community. The article examines which international funds and organizations and how exactly they help Ukraine in solving this problem. Humanitarian aid is usually aimed at saving human life, reducing suffering, helping to survive difficult circumstances, and preventing the occurrence of epidemics. Accordingly, the main tasks of humanitarian aid are: saving human life; provision of assistance to meet basic human needs (water, food, accommodation); provision of basic hygiene and medical care. The analysis of humanitarian aid delivered to Ukraine makes it possible to make the following conditional division into the main types of humanitarian aid: humanitarian aid of military purpose (equipment, equipment, equipment, etc.); medical humanitarian aid (both civilian and military medicine); humanitarian aid to the civilian population (food needs – food, hygiene products, clothes and shoes, sanitation, household goods, etc.); fuel (both for military needs and for civil defense needs). Humanitarian aid is provided free of charge to people who need it. All strata of the population received humanitarian aid in Ukraine. One of the main goals of humanitarian aid is to save human life, it is unplanned and can be provided both in kind and in cash, and the provision of free services is also considered humanitarian aid. Humanitarian aid began to arrive in Ukraine from the very beginning of the war, because even crossing the border to the countries bordering Ukraine, its citizens arranged free flights and provided housing for refugees, caring people fed and provided basic necessities, warm things and hot drinks to the defenseless citizens of Ukraine who fled the war.

Optimal pricing and budget decisions in public health systems with delay sensitive patients

Abstract The congestion of public hospitals for elective treatment in some countries and regions, such as Canada and Hong Kong where the free health policy is implemented, is a serious issue. The main reason is the excessive demand generated by the provision of free service. In response, the government can set appropriate service price and budget for public hospitals to moderate such demand. This is often referred to as the charging policy, implemented in countries such as China. A Stackelberg game is established for a health system consisting of a government, a public health provider and delay sensitive patients. The results show that when the customers' waiting cost is low (e.g., the market demand, the patients delay sensitivity, or the unit capacity cost is low), the free health policy outperforms the charging policy; otherwise, the charging policy is better. Moreover, we find that the equilibrium waiting time and the equilibrium price decrease with the market demand when the funder attaches more importance to patients’ welfare than the budget surplus and the total budget is sufficient.

The internal market for supplementary pensions: A long and winding road

Since the beginning of the 1990s, EU initiatives have sought to gradually harmonize the activities of institutions for retirement provisions (‘IORPs’). However, thirty years later, multiple barriers to entry remain. This article will identify the current state of play, by adopting a twofold approach towards supplementary pensions in a context of EU internal market law. First, we will assess the process of negative integration of several pension policy tools in light of the free movement case law (in particular, the free provision of services). During this study, the focus will be on mechanisms of compulsory membership and collective bargaining in the field of occupational pensions. Second, we will analyse the most important legislative constraints of supplementary pension services at EU level, with an emphasis on secondary internal market law. We argue that, despite the effort of respecting national autonomy in social policy, positive integration has led to several spillovers. Finally, the article will highlight the most significant obstacles, and conclude by discussing the general attitude of EU internal market law towards supplementary pensions and social policy in general.

Barriers to and facilitators of South Asian immigrant adolescents’ access to sexual and reproductive health services in Canada: A qualitative study

Data on immigrant access to sexual and reproductive health (SRH) services in Canada typically focus on adult populations generally but not adolescents specifically. To fill this gap, this study explored South Asian immigrant adolescents’ perceptions of barriers and facilitators for SRH care and services in Edmonton, Alberta, Canada. In this qualitative descriptive study, researchers conducted six focus group semi-structured interviews with South Asian immigrant adolescents who live in Edmonton, Canada. Barriers included fear of stigma and judgment, lack of information about the healthcare system, lack of privacy and youth-friendly SRH services, lack of comprehensive sexuality education, lack of trust of online SRH information, and language barriers. Facilitators included SRH information classes at school, parental support, and provision of free services. South Asian immigrant adolescents expressed their need for more inclusive and relevant sexual health education, more support from parents and teachers with adequate and evidence-based SRH information and effective communication strategies to enhance communication with adolescents, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centered sexual health education at home, in school, and in the community.

‘They say we are money minded’ exploring experiences of formal private for-profit health providers towards contribution to pro-poor access in post conflict Northern Uganda

ABSTRACT Background: The perception within literature and populace is that the private for-profit sector is for the rich only, and this characteristic results in behaviours that hinder advancement of Universal health coverage (UHC) goals. The context of Northern Uganda presents an opportunity for understanding how the private sector continues to thrive in settings with high poverty levels and history of conflict. Objective: The study aimed at understanding access mechanisms employed by the formal private for-profit providers (FPFPs) to enable pro-poor access to health services in post conflict Northern Uganda. Methods: Data collection was conducted in Gulu municipality in 2015 using Organisational survey of 45 registered formal private for-profit providers (FPFPs),10 life histories, and 13 key informant interviews. Descriptive statistics were generated for the quantitative findings whereas qualitative findings were analysed thematically. Results: FPFPs pragmatically employed various access mechanisms and these included fee exemptions and provision of free services, fee reductions, use of loan books, breaking down doses and partial payments. Most mechanisms were preceded by managers’ subjective identification of the poor, while operationalisation heavily depended on the managers’ availability and trust between the provider and the customer. For a few FPFPs, partnerships with Non-governmental organisations (NGOs) and government enabled provision of free, albeit mainly preventive services, including immunisation, consultations, screening for blood pressure and family planning. Challenges such as quality issues, information asymmetry and standardisation of charges arose during implementation of the mechanisms. Conclusion: The identification of the poor by the FPFPs was subjective and unsystematic. FPFPs implemented various innovations to ensure pro-poor access to health services. However, they face a continuous dilemma of balancing the profit maximization and altruism objectives. Implementation of some pro-poor mechanisms raises concerns included those related to quality and standardisation of pricing.

Factors Affecting Cervical Cancer Screening among Women Below 25 Years in Kithare Area, Tharaka Nithi County, Kenya

Cervical cancer is the most common neoplasm among women globally affecting approximately 500,000 women with 275,000 succumbing to the disease every year. The prevalence of cervical cancer is disproportionately high in sub-Saharan Africa where the screening rate is low. The study sought to assess the factors affecting cervical cancer screening among women aged 15 - 25 years in Kithare area Tharaka Nithi County. The study was a descriptive cross-sectional study and interviewer administered questionnaires were used to capture the level of knowledge, individual perspectives, attitude and barriers influencing cervical cancer screening. This study was conducted between August and September 2018 with the sample size being 80 respondents. From the findings a significant number of women had two or more sexual partners. The level of knowledge on cervical cancer was significantly low as (55%, n = 44) were aware about the disease, (45%, n = 36) had the correct knowledge when to seek screening, (40%, n = 32) knew the correct interval for attending screening and only (18.7%, n = 15) had been screened before. Reasons for seeking screening for the 18.7% were to know their health status, due to abnormal discharge or as a result of bleeding. (86.3%, n = 69) believed that screening was helpful with reasons being; for early detection of the disease, to know the health status, to prevent infertility and death. (13.7%, n = 11) believed that screening was not helpful with reasons being; the procedure is uncomfortable, painful, it leads to a low self-esteem, fear of wrong results and the diagnosis of cancer. Barriers citied to cervical cancer screening were; inadequate knowledge, negative attitude towards screening, lack of the screening services and cost of services. The knowledge and practice of cervical cancer screening was inadequate. More education on screening should be provided to reduce the misconceptions involved. Provision of free services and more participation in education and sensitization from the healthcare providers should also be done.

Accessing medicines for non-communicable diseases: Patients and health care workers' experiences at public and private health facilities in Uganda.

Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients' confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.

Balancing social and economic fundamental rights in the EU legal order

The EU legal order recognises at its highest level both fundamental social rights/freedoms and economic rights/freedoms. As is well-known, it is in the cases where these have had to be balanced against one another, that profound legal and political difficulties have appeared over the years, feeding into a more general concern about an asymmetry between social and economic values and outcomes in the European integration process. While we need to be careful not to overstate the extent of conflict, it deserves to be reiterated that there remain a number of important ‘social sore spots’ that despite sustained academic and political critique, and despite some adjustments in the Court’s approach, continue to emerge and challenge the EU’s social legitimacy. The EU’s approach towards the right to strike and bargain collectively in relation to the internal market provisions on the free provision of services and establishment, which has not only met with criticism internally but has also been considered at odds with international social rights, remains problematic in spite of the CJEU’s more recent ‘conciliatory’ case law. Moreover, relatively recent (r)evolutions in the case law as regards the freedom to conduct a business have raised important new tensions. In accordance with its brief, this article maps these frictions and, more importantly, considers how the adjudication of these rights could be conducted differently. In this regard, it argues that the most appropriate alternative approach is one not directed at procuring more ‘social’ outcomes as such, but instead one that provides a more constitutionally and democratically legitimate framework of adjudication of fundamental rights generally, and social and economic rights specifically. Indeed, while this paper therefore shares the fundamental ambition of some other thought-provoking approaches proposed recently to provide the European judiciary with an alternative framework for the balancing of social and economic rights, the proposal of this paper is different in the importance it attaches to democracy. Democracy shall be the guiding concern in the proposed framework, not only by ensuring that the extent to which these rights are enforced against the national and European legislative process remains limited to what is necessary, but also in providing the dominant telos that should inform the substantive interpretation of these rights.

Planificación urbanística del turismo: la regulación de las viviendas de uso turístico en Madrid y Barcelona

Las importantes restricciones que el planeamiento urbano ha impuesto a las viviendas de uso turístico en las ciudades de Madrid y Barcelona imponen un examen de estas medidas desde el punto de vista de los principios de buena regulación económica, la libre prestación de servicios y la protección de los derechos fundamentales de ciudadanos en general y de propietarios de viviendas en particular.

Barriers for service providers in the EU internal market

The free provision of services in the European Internal Market is still being prevented from coming into fruition by serious obstacles. The crucial step to the elimination of barriers and liberalization of market access for service providers was to be the implementation of the Services Directive in 2009. However, the provision of services across the EU is still subject to restrictions stemming mostly from differences in the Member States’ national regulations and, therefore, service providers cannot exploit the potential of the EU Internal Market to the full extent. The aim of the paper is to identify barriers preventing service providers from free access to the European Internal Market and to present the most important ones. The paper is based on an analysis of the literature, especially of documents and reports of the EU institutions and other European research bodies. The obstacles facing service providers in the European Internal Market are mainly of a regulatory nature. The most significant ones include differences in legislation and a lack of initiative to simplify it, problems with access to information, differences in the recognitionm of qualifications resulting in restrictions on access to service activities, divergent and disproportionate regulations of service professions and, last but not least, problems with civil liability insurance for service providers.

Patients\u2019 willingness to pay for the treatment of tuberculosis in Nigeria: exploring own use and altruism

BackgroundAlthough, current treatment services for Tuberculosis (TB) in Nigeria are provided free of charge in public facilities, the benefits (value) that patients attach to such service is not known. In addition, the prices that could be charged for treatment in case government and its partners withdraw from the provision of free services or inclusion of the services in health insurance plans are not known. Hence, there is a need to elicit the maximum amounts that patients are willing to pay for TB treatment services, both for themselves and for the very poor patients that may not be able to pay if some user fees are introduced (altruistic willingness to pay).MethodsA pretested interviewer-administered questionnaire was used to elicit the maximum willingness to pay (WTP) for TB treatment services from TB patients in a tertiary hospital in southeast Nigeria. WTP was elicited using the bidding game question format after a scenario was presented to the respondents. Data was analysed using tabulations. Tobit regression models were used to examine the validity of the elicited WTP for own use and altruistic WTP.ResultsThe results show that those aged 30 years and below constituted more than two-fifth (43.2%) of the respondents. More than half of the respondents (52.8%) were not employed. 100 (80.0%) of the respondents were willing to pay for their own use of TB treatment services while 78(62.4%) of the respondents were willing to make altruistic contributions so that the very poor could benefit from the TB services. A Tobit regression analysis of maximum WTP for TB for own use shows that respondents were willing to pay maximum amounts at different statistically significant levels. The results equally show that altruistic WTP was positively and statistically significantly related to the employment status, distance from UNTH and global seriousness of TB.ConclusionsMost patients positively valued the provision of free TB services and were willing to pay for TB treatment for own use. The better-off ones were also willing to make altruistic contributions. Free provision of TB treatment services is potentially worthwhile, but there is potential scope for continuation of universal provision of TB treatment services, even if the government and donors scale down their financing of the services.

The Application of EC Treaty Rules to Sport: the Approach of the European Court of First Instance in the <i>Meca Medina</i> and <i>Piau</i> cases

In the Meca Medina and Piau cases, the European Court of First Instance had to deal for the first time with the application of EC Treaty provisions to sports bodies’ rules. The first of these two cases concerned anti-doping rules adopted by the IOC and the second one concerned FIFA regulations on players’ agents. According to case-law of the European Court of Justice, rules ‘of purely sporting interest’ do not fall within the scope of the EC Treaty. However, an overview of the relevant judgments shows that the test adopted since Walrave to assess the ‘purely sporting’ nature of such rules is not fully clear and has not always been applied in a consistent way, in particular after Bosman. The Meca Medina case, in which the European Court of First Instance has applied the test in a slightly different manner, opens the door to substantial simplification of future case-law. On the other hand, the European Court of First Instance has also taken the view that the test, which had only been applied up to now by the European Court of Justice to EC Treaty rules on free movement of workers and free provision of services, extends also to the rules on competition. Piau, delivered by the European Court of First Instance some months later, has confirmed the confusion that may derive from traditional case-law and has shown the risks that may derive from the adoption of divergent decisions within the European judicial system.

Economic freedoms and labour standards in the European Union

The European Union internal market seeks to ensure the free movement of goods, services, capital and citizens. The primacy given to these economic freedoms has culminated in a socio-economic reasoning dominated by competition, bringing about side effects that may pose a threat to working conditions and labour standards. This article examines the problematic relationship between economic freedoms and labour standards in the context of cross-border labour recruitment. It starts with a summary of the relevant EU acquis, in particular rules concerning social security coordination and the pay and working conditions of posted workers. It reviews key issues of the ‘hard core’ of the internal market legislation (free choice of contracts, freedom of establishment for firms, deregulation of the ‘business environment’ and free provision of services). The next part identifies experiences of rule-enforcing institutions: regime shopping, non-compliance with social standards, lack of cross-border enforcement, the difficulty of tracing circumvention in a transnational context and weak sanctioning mechanisms. The possibility of verifying, legally and in practice, whether a worker is correctly posted within the framework of the provision of services has become an Achilles heel of the enforcement of the use of cross-border recruited labour. The article also assesses whether the 2014 Enforcement Directive can be seen as an effective remedy for the identified problems.

Inequality and inequity in healthcare utilization in urban Nepal: a cross-sectional observational study.

Inequality in access to quality healthcare is a major health policy challenge in many low- and middle-income countries. This study aimed to identify the major sources of inequity in healthcare utilization using a population-based household survey from urban Nepal. A cross-sectional survey was conducted covering 9177 individuals residing in 1997 households in five municipalities of Kathmandu valley between 2011 and 2012. The concentration index was calculated and a decomposition method was used to measure inequality in healthcare utilization, along with a horizontal inequity index (HI) to estimate socioeconomic inequalities in healthcare utilization. Results showed a significant pro-rich distribution of general healthcare utilization in all service providers (Concentration Index: 0.062, P < 0.001; HI: 0.029, P < 0.05) and private service providers (Concentration Index: 0.070, P < 0.001; HI: 0.030, P < 0.05). The pro-rich distribution of probability in general healthcare utilization was attributable to inequalities in the level of household economic status (percentage contribution: 67.8%) and in the self-reported prevalence of non-communicable diseases such as hypertension (36.7%) and diabetes (14.4%). Despite the provision of free services by public healthcare providers, our analysis found no evidence of the poor making more use of public health services (Concentration Index: 0.041, P = 0.094). Interventions to reduce the household economic burden of major illnesses, coupled with improvement in the management of public health facilities, warrant further attention by policy-makers.

The Fallacy of Informed Consent: Linguistic Markers of Assent and Contractual Design in Some E-User Agreements

Orthodox contract law theory assumes that parties agree to the terms of a contract before entering into an agreement. However, recent factual evidence points towards the fact that consumers do not systematically read, and thus become informed of, the terms of a contract. Academics are asking for mandatory frameworks to ensure that informed consent is indeed sought and given by parties to a contract. The present study looks into the user agreements of four online companies that provide a marketplace for the sale of goods or free provision of services by other sellers and/or users (Ebay, Tripadvisor, YouTube and Amazon). The aim is firstly to identify the lexical/textual markers and peri-textual features of agreement in order to highlight the fallacy of informed consent. Secondly, the paper lists textual and peri-textual alternative contractual design (here called counter-design) in online user agreement. In so doing, contractual design features are distinguished from nudges. Suggested counter-design features help make informed consent effective.

Customer Differentiation in Ancillary Services? Free Service, Prioritization, and Strategic Delay

A service provider/retailer offers ancillary service (e.g., shipping, cloud computing) to two types of customers, impatient and patient, who may be heterogeneous both in their delay sensitivities and service valuations. She can use prioritization and strategic delay to differentiate them. She offers at most two service classes and can price them so that a customer type splits between them. Her objective is to minimize cost while satisfying individual rationality and incentive compatibility conditions. We consider the retailer's problem and characterize the optimal solution when capacity is both exogenous and endogenous. We show that (i) the retailer prioritizes whenever two service classes are offered and (ii) splitting of impatient customers can be optimal. We also find when free service provision is optimal; it is due to two reasons: better customer differentiation and low capacity. We study numerically how optimal service delivery and cost change with different parameters, and derive more insights.

Free provision of services and cross-border labour recruitment

This article identifies how the use of the European Union (EU) mobility rules, as formulated by the EU's Posting Directive, has been linked to the temporary provision of services in practice. It demonstrates how this linkage, legitimised by European Court rulings, undermines the Directive's original intent to provide rights-based regulation of labour mobility in the Union. In the assessment of posting practices, striking findings of two studies co-conducted by the author in 2003 and 2010 are discussed. In the first section, the origins of the Directive are described, followed by sections that contextualise the posting rules in the framework of the fundamental economic freedoms of EU Treaties, and discuss the problems related to implementation and enforcement. Based on the Directive's definition of posting, three issues of governance and practice are raised: (a) regulation of the employment relationship, (b) application of labour conditions and (c) respect for collective agreements. A final section offers policy recommendations in order to deal with the ways in which posting governance and practices currently impede any vision of rights-based mobility in the EU. It is argued that current minimalist interpretation of the posting rules can neither guarantee equal treatment nor protect the rights of temporary migrant workers.

El Programa de Interrupción Legal del Embarazo en la Ciudad de México: experiencias del personal de salud

Identify the perceptions and opinions of people who provide abortion services in Mexico City, three years after implementation of elective abortion legal reforms. Nineteen in-depth interviews of health workers assigned to the legal abortion programs at a clinic and a hospital in Mexico's Federal District were carried out between February and June of 2010. Information on sociodemographic data, professional training, and experience in providing services was collected. Some interviewees thought the provision of free services was beneficial because it allowed lower-income women to access this type of care, whereas others interviewed disapproved of the lack of fees, since other gynecological and obstetric health services have to be paid for. Conscientious objection prevailed among newly hired health workers, which can be attributed to their lack of knowledge about the legal abortion program's legal and technical guidelines. Some workers were ambivalent because they did not accept a postabortion contraception method used by some women, perceiving it to be a factor in significant repeated demand for legal abortion services. Health workers evince divided and ambivalent opinions with regard to abortion rights. Analyzing their experiences and opinions will facilitate the creation of a baseline on the subject, and future studies will be able to document changes in and any lessening of approval for this law in Mexico.

Barriers to mammography among underserved women in a breast health center outreach program.

13 Background: An outreach registry of Breast Health Center patients was developed in 2006 to evaluate the effectiveness of mobile mammography among the medically underserved. Registry included collection of medical record data, demographic data, and answers to a questionnaire about perceptions of breast cancer screening. Here, we examine barriers to mammography. Methods: Between April 2006 and May 2011, 9,082 women were registered. Data from registrants’ first screening visit (n= 8,916) were analyzed using multivariable logistic regression examining three outcomes identified as barriers to mammography: cost, fear of pain during the procedure, and fear of receiving bad news. Two-tailed p&lt;0.05 was considered significant. Results: The majority of registrants were black (54%), uninsured (74%), screened on a van (83%), resided in the greater St. Louis region (84%), had an annual income &lt;$20,000 (87%), and reported a good or excellent experience as part of the outreach program (92%). Fears of cost, mammogram-related pain, and bad news were reported by 40%, 13%, and 13% of registrants, respectively. Regression analyses revealed that being employed (odds ratio [OR] 1.109, p=0.0323) and living in the Bootheel of Missouri (OR 2.319, p&lt;0.0001) were associated with a higher likelihood of perceiving cost as a barrier to mammography, while those who had insurance (OR 0.439) and were Hispanic (compared to non-Hispanic [NH] whites [OR 0.338]) were less likely to report cost as a barrier (both p&lt;0.0001). Registrants who were screened on the van (OR 1.633), had insurance (OR 1.391), and were NH black (OR 1.324) were more likely to report fear of procedural pain as a barrier (all p&lt;0.0001). Having insurance (OR 1.378), being NH black (OR 2.458), and being Hispanic (OR 2.980) were associated with reporting fear of receiving bad news as a barrier (all p&gt;0.0001), while older women (OR 0.985, p=0.0001) and women who were screened on the van (OR 0.772, p=0.0026) were less likely to report this concern. Conclusions: Despite provision of free services, cost, fear of procedural pain, and fear of abnormal results remain barriers to mammography utilization among medically underserved women, suggesting the need for more breast health education in this population.