Health Serv Res. 2016 Mar 15. doi: 10.1111/1475-6773.12477. [Epub ahead of print]

Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates.

Bitler MP1, Carpenter CS2,3,4.

Author information

• 1Department of Economics, University of California, Davis, Davis, CA.
• 2Department of Economics, Vanderbilt University, Nashville, TN.
• 3Department of Health Policy, Vanderbilt University, Nashville, TN.
• 4Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN.

Abstract

OBJECTIVE:

To evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women.

DATA SOURCES:

Individual-level data on 600,000 women age 19-64 from the CDC's Behavioral Risk Factor Surveillance System.

STUDY DESIGN:

Twenty-four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference-in-differences analysis comparing within-state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate.

PRINCIPAL FINDINGS:

Difference-in-differences estimates indicated that the Pap test mandates significantly increased past 2-year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non-Hispanic white women. These effects are plausibly concentrated among insured women.

CONCLUSIONS:

Mandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.