Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates

Area of Science:

• Health Services Research
• Public Health Policy
• Preventive Medicine

Background:

• Cervical cancer screening is recommended for most adult women.
• Pap tests are a standard screening method for cervical cancer.
• Insurance coverage influences access to preventive health services.

Purpose of the Study:

• To evaluate the impact of state insurance mandates on Pap test coverage.
• To assess how mandates affect cervical cancer screening rates.
• To identify disparities in mandate effectiveness.

Main Methods:

• Utilized individual-level data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS) for 600,000 women aged 19-64.
• Employed a difference-in-differences analysis comparing Pap test rates before and after state mandate adoption (1988-2000).
• Controlled for changes in states without mandates to isolate the effect of the mandates.

Main Results:

• State mandates for Pap test coverage significantly increased past 2-year cervical cancer screenings by 1.3 percentage points.
• Mandate effects were larger for Hispanic and non-Hispanic white women.
• The observed increases in screening were likely concentrated among insured women.

Conclusions:

• Mandating insurance coverage for routine, inexpensive services like Pap tests can further increase utilization.
• Insurance mandates are an effective policy tool to enhance preventive screening rates.
• Policy interventions can help improve access to essential cancer screenings.