The importance of health insurance as a determinant of cancer screening: Evidence from the Women's Health Initiative

Background. Amid current changes in health care access across the United St ates, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This an alysis evaluates the hypothesis that health insurance independently predict s cancer screening in the Women's Health Initiative Observational Study coh ort. Methods. Questionnaire data from 55,278 women enrolled in the Women's Healt h Initiative Observational Study between September 1994 and February 1997 w ere analyzed by multiple logistic regression to identify predictors of self -reported mammography within 2 years, Pap smear within 3 years, and stool g uaiac or flexible sigmoidoscopy within 5 years. Results. Positive determinants of reporting cancer screening were age, ethn ic origin, household income, educational level, family history of cancer, h aving a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovas cular events were negative determinants of cancer screening. Among women yo unger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independe ntly of having or using a usual care provider and of demographics, self-per ceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. Conclusions. In the Women's Health Initiative Observational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening independent of demograp hics, chronic health conditions, and self-perceived health characteristics. (C) 2000 American Health Foundation and Academic Press.