Perceptions of insurance coverage for screening mammography among women in need of screening

Abstract

Background: Breast carcinoma remains a significant health problem in the U.S., especially among underserved populations. Although screening mammography is recommended for early detection, in 2002, approximately 25% of women age > 40 years had not had a mammogram within the past 2 years. The current study examined perceptions of insurance coverage and cost as barriers to screening mammography within an underserved, predominantly low-income population of women in need of a mammogram.

Methods: Between 1998 and 2002, face-to-face interviews were conducted with 897 women age > or = 40 years. All women were part of a randomized, controlled study evaluating a health education intervention designed to improve mammography screening. They were asked questions at baseline about cost and insurance coverage as barriers to mammography screening. Women's reports of their level of insurance coverage for mammography were compared with actual coverage by their insurance type to determine the accuracy of their perception of insurance coverage for mammography. The relation between perception of insurance coverage and the barrier of cost was investigated.

Results: Greater than half of the women who needed a mammogram identified cost as a barrier to mammography; however, 40% of these women had an inappropriate perception of their insurance coverage. Underestimating or not knowing the level of mammography coverage was strongly associated with reporting cost-related difficulty (odds ratio [OR] = 4.57, 95% confidence interval [95% CI], 1.95-10.70 for the underestimate category; OR = 4.42, 95% CI, 1.80-10.88 for the don't know category), regardless of true coverage levels.

Conclusions: Providing women with information regarding their actual coverage for mammograms may reduce the impact of cost as a barrier to screening mammography.

FIGURE 1

Distribution of women’s perception of insurance coverage for a screening mammogram, by insurance status (n = 892). Chi-square test of homogeneity: χ²(5) = 313.3; P < 0.0001. Inappropriate includes the categories of underestimate, overestimate, and does not know. Striped bars: inappropriate; dark bars: appropriate.