Health insurance and mammography: would a Medicare buy-in take us to universal screening?
Health insurance and mammography: would a Medicare buy-in take us to universal screening?
复制标题
健康保险和乳房X光检查：医疗保险的支持会让我们进行全民筛查吗？
DOI：
10.1111/1475-6773.01312
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发表时间：
2002
影响因子：
3.4
通讯作者：
Hawley,SarahTropman
中科院分区：
文献类型：
--
作者：
TaylorJr,DonaldH;VanScoyoc,Lynn;Hawley,SarahTropman
目的：确定通过购买联邦医疗保险扩大医疗保险是否可能可信地提高50-64岁女性的乳房X光检查筛查率。数据来源：健康与退休研究(HRS)的两波(1994,1996)。研究设计。在第二波HRS(1994)测量的大多数解释变量的纵向研究；数据提炼：我们的样本包括1994年接受第二次和第三次HRS访问的50-62岁的女性(n=4,583)。主要发现：从1994到1996，72.7%的女性接受了乳房X光检查。投保后，在未调整和调整后的分析中都增加了乳房X光检查。对这一年龄段的全民保险覆盖范围的模拟仅将乳房X光摄影率从观察到的72.7%提高到75%-79%。当我们考虑了医生就诊和BSE对乳房X光检查的潜在内源性时，医生就诊仍然是乳房X光检查的一个强有力的预测因素，但BSE并非如此。结论：即使在全民保险和非常乐观的情况下，保险对新参保女性进行乳房X光检查的影响，乳房X光检查的比率只会增加很小的幅度，筛查方面的差距仍然存在。因此，可以预期，联邦医疗保险的加入将对乳房X光检查筛查率产生微小影响。
Objective.To determine whether health insurance expansions via a Medicare buy‐in might plausibly increase mammography screening rates among women aged 50–64.Data Sources.Two waves of the Health and Retirement Study (HRS) (1994, 1996).Study Design.A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996).Data Extraction.Our sample included women aged 50–62 in 1994 who answered the second and third HRS interview (n=4,583).Principal Findings.From 1994 to 1996, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in this age group increased mammography rates only to 75–79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammography, physician visits remained a strong predictor of mammography but BSE did not.Conclusion.Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy‐in could be expected to have a small impact on mammography screening rates.