The impact of mandatory insurance coverage of preventive cancer screenings on consumers

University of Minnesota Ph.D dissertation. August 2013. Major: Health Services Research, Policy and Administration. Advisor: Bryan Dowd. 1 computer file (PDF); v, 102 pages.This work seeks to understand the association between state and federal mandatory health insurance benefits 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 and federal 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. The project studies two samples of beneficiaries: a sample of privately insured adults under age 65 are analyzed for utilization of cervical, prostate and colorectal cancer screenings respectively; another sample of Medicare fee-for-service beneficiaries who are 65 years of age and older are analyzed for consumption of prostate and colorectal cancer screenings. Overall, the findings suggest that mandated coverage does not increase consumption of preventive care among privately insured adults, either in aggregate or for different demographic subgroups. Medicare coverage of prostate and colorectal cancer screenings are associated with increased fee-for-service claims billed for these services. Coverage mandates do result in income transfers from disadvantaged non-users to relatively well-off 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