Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb;52(1):156-175.
doi: 10.1111/1475-6773.12477. Epub 2016 Mar 15.

Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates

Marianne P Bitler  1 , Christopher S Carpenter  2   3   4
Affiliations

Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates

Marianne P Bitler et al. Health Serv Res. 2017 Feb.

Abstract

Objective: To evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women.

Data sources: Individual-level data on 600,000 women age 19-64 from the CDC's Behavioral Risk Factor Surveillance System.

Study design: Twenty-four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference-in-differences analysis comparing within-state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate.

Principal findings: Difference-in-differences estimates indicated that the Pap test mandates significantly increased past 2-year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non-Hispanic white women. These effects are plausibly concentrated among insured women.

Conclusions: Mandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.

Keywords: Insurance mandates; Pap tests; cervical cancer; difference-in-differences.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Pap Test Rates among 19‐ to 64‐Year‐Old Women, BRFSS 1988–2000
See this image and copyright information in PMC

References

    1. Adams, E. , Breen N., and Joski P.. 2006. “Impact of the National Breast and Cervical Cancer Early Detection Program on Mammography and Pap Test Utilization among White, Hispanic, and African American Women: 1996‐2000.” Cancer 109 (2 Suppl.): 348–58. - PubMed
    1. Adams, E. , Florence C., Thorpe K., Becker E., and Joski P.. 2003. “Female Cancer Screening, 1996‐2000.” American Journal of Preventive Medicine 25 (4): 301–7. - PubMed
    1. Akosa Antwi, Y. , Moriya A., and Simon K.. 2013. “Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act's Dependent Coverage Mandate.” American Economic Journal—Economic Policy 5 (4): 1–28.
    1. American Cancer Society . 2008. “Chronological History of ACS Recommendations of Early Detection of Cancer” [accessed on October 31, 2008]. Available at http://www.cancer.org/docroot/PED/content/PED_2_3X_Chronological_History...
    1. Baker, L. , and Chan J.. 2007. “Laws Requiring Health Plans to Provide Direct Access to Obstetricians and Gynecologists, and Use of Cancer Screening by Women.” Health Services Research 42 (3): 990–1006. - PMC - PubMed

Publication types

MeSH terms