Poster Paper: Lessons From State Laws: Do Coverage Mandates for Preventive Cancer Screenings Change Behavior?

Saturday, November 9, 2013
West End Ballroom A (Washington Marriott)

*Names in bold indicate Presenter

Wendy Yi Xu, Bryan Dowd and Jean Abraham, University of Minnesota
The recent Federal and state legislative activities highlight the importance of understanding whether mandatory health insurance benefits effective strategies to promote preventive cancer screenings. This paper seeks to understand the association between state health insurance mandates and utilization of several preventive cancer screenings and the induced income transfers among consumers. The specific aims are: (1) to estimate the effect of state mandated benefits of preventive care on use of cancer screenings; (2) to estimate how non-price barriers relate to compliance with screenings; (3) to quantify the income transfers induced by mandated coverage.

Substantial variations with respect to the timing of state mandates that went into effect provided a natural experimental design for the study. A Difference-in-Difference model is paired with this design to estimate the change in utilization of preventive screenings because of state mandated benefits. The primary data comes from the 1997-2008 Medical Expenditure Panel Survey (MEPS). It is supplemented by the Bureau of Health Profession’s Area Resource Files (ARF) for local physician supply and the hand-collected state preventive mandates. The national average price of preventive cancer screenings paid by insurance plans is used to quantify the income transfers between non-users and users.  

A sample of privately insured adults under age 65 was analyzed for utilization of preventive cervical, prostate and colorectal cancer screening respectively. Overall, the findings suggest that mandated coverage does not increase consumption of preventive care either in aggregate or for different demographic subgroups. The findings are robust to a variety of sensitivity analyses. While coverage mandates are ineffective in achieving increased cancer screening, mandates do result in income transfers from non-users to users of preventive care. Some non-price social determinants are associated with large redistributive effects, including being an Asian, less educated, lack of English proficiency and lack of usual source of care, and living in isolated areas without adequate physician supply. It is shown that each individual who is eligible to use the service but have forgone it due to other barriers, potentially subsidize the users by $437. The redistributive of income appear to be regressive – moving income from disadvantaged non-users to relatively well-off users.

Although reducing the out-of-pocket cost of preventive care has become a widely accepted public policy, state and federal governments should consider both the price effects and the distributional effects of mandate coverage with the health care reform. Mandated coverage has redistributive effects that may exacerbate the inequalities among individuals. Public policies that focus on the non-price factors affecting consumption of preventive care, such as increasing access to regular sources of care, education programs that target on people with poor health literacy, subsidies to language services for those difficult with English, and increasing physician availabilities in rural areas, might be both more efficient and more equitable, as well.