Financial barriers to mammography: who pays out-of-pocket?

OBJECTIVE: This study investigates how out-of-pocket payments for mammograms vary according to the characteristics of women and the states where they reside.
METHODS: We conducted a cross-sectional analysis for women >or=40 years using data from the 2000 National Health Interview Survey (NHIS) Cancer Control Module linked with state characteristics. Descriptive tabulations and logistic regressions were used to examine characteristics associated with out-of-pocket payment for a woman's most recent mammogram for the subset of approximately 7000 women reporting a mammogram within the past 2 years.
RESULTS: In 2000, the majority of women who received a mammogram within the past 2 years paid no out-of-pocket costs: 68% among those aged 40-64 and 85% among those aged >or=66. Among women aged 40-64 with a recent mammogram, characteristics associated with paying out-of-pocket for the last mammogram were white, non-Hispanic race/ethnicity, being uninsured, having non-HMO private coverage, place of residence outside the Northeast, in a non-metropolitan county, and in a state with low HMO penetration.
CONCLUSIONS: Public insurance and HMO coverage have been especially effective in eliminating financial barriers to mammography, but women 40-64 years with public coverage still lag behind their privately insured counterparts in using mammography. Out-of-pocket costs remain a barrier to use for uninsured women. Older women, although less likely than younger women to pay out-of-pocket for mammograms, remain less likely to use mammography than younger women.