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Are gatekeeper requirements associated with cancer screening utilization?
Kathryn A Phillips1, Jennifer S Haas, Su-Ying Liang
1School of Pharmacy, Institute of Health Policy Studies, UCSF Comprehensive Cancer Center, University of California, San Francisco 94143, USA.
Health Services Research
|February 18, 2004
Summary
Health plans requiring gatekeepers, or primary care providers coordinating care, are linked to increased cancer screening for women. However, these requirements did not affect prostate cancer screening rates.
Area of Science:
- Health Services Research
- Preventive Medicine
- Health Policy
Background:
- Debate exists on whether health plans should mandate
- gatekeepers
- primary care providers who coordinate care and control specialist access.
- The impact of gatekeeper requirements on healthcare quality remains unclear.
- This study investigates the association between gatekeeper requirements and cancer screening utilization.
Purpose of the Study:
- To examine the relationship between health plan gatekeeper requirements and the utilization of cancer screening for breast, cervical, and prostate cancer.
Main Methods:
- Utilized cross-sectional, multivariate logistic regression analysis.
- Data derived from three linked sources: Medical Expenditure Panel Survey (MEPS) Household Survey (1996), MEPS Health Insurance Plan Abstraction (1996), and National Health Interview Survey (1995).
- Sample size (N) = 13,534.
Main Results:
- Women enrolled in gatekeeper plans showed significantly higher rates of mammography, clinical breast examinations, and Pap smears compared to those not in gatekeeper plans.
- Gatekeeper requirements were not associated with increased prostate cancer screening utilization.
- No association was found between screening utilization and aggregate health plan types (HMO, POS, PPO, FFS).
Conclusions:
- Gatekeeper requirements are associated with increased use of recommended cancer screening procedures for women.
- The association does not extend to prostate cancer screening, which is less uniformly recommended.
- Future research should analyze specific plan characteristics, and policymakers should consider gatekeepers' benefits for preventive care.