Laurence C Baker1, Jia Chan. 1. Department of Health Research and Policy, Stanford University, Center for Health Policy, Stanford University, National Bureau of Economic Research, Stanford University, Stanford, CA 94305-5405, USA.
Abstract
BACKGROUND: Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter "ob/gyns") for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no literature has examined the relationship between ob/gyn direct access laws and use of breast cancer and cervical cancer screening. DATA AND METHODS: We use repeated cross-sections of privately insured women age 18-64 (Pap test) and 40-64 (mammography) from the Behavioral Risk Factor Surveillance System for 1996-2000, linked to data on the presence of ob/gyn direct access laws by state. Outcome measures are receipt of mammography and receipt of a Pap test within the past 2 years. Regression analyses are used to assess the relationship between the presence of ob/gyn direct access laws and screening, adjusting for a range of individual characteristics, fixed state characteristics, and time trends. RESULTS: We find no statistically significant relationships between the presence of an ob/gyn direct access law and receipt of either mammography or Pap test screening. We explore a range of alternate specifications and find none that yield clear evidence of a relationship. CONCLUSIONS: Laws requiring direct access to ob/gyns are not associated with large or consistent measurable impacts on use of cancer screening.
BACKGROUND: Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter "ob/gyns") for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no literature has examined the relationship between ob/gyn direct access laws and use of breast cancer and cervical cancer screening. DATA AND METHODS: We use repeated cross-sections of privately insured women age 18-64 (Pap test) and 40-64 (mammography) from the Behavioral Risk Factor Surveillance System for 1996-2000, linked to data on the presence of ob/gyn direct access laws by state. Outcome measures are receipt of mammography and receipt of a Pap test within the past 2 years. Regression analyses are used to assess the relationship between the presence of ob/gyn direct access laws and screening, adjusting for a range of individual characteristics, fixed state characteristics, and time trends. RESULTS: We find no statistically significant relationships between the presence of an ob/gyn direct access law and receipt of either mammography or Pap test screening. We explore a range of alternate specifications and find none that yield clear evidence of a relationship. CONCLUSIONS: Laws requiring direct access to ob/gyns are not associated with large or consistent measurable impacts on use of cancer screening.
Authors: Lee S Caplan; David V McQueen; Judith R Qualters; Marilyn Leff; Carol Garrett; Ned Calonge Journal: Cancer Epidemiol Biomarkers Prev Date: 2003-11 Impact factor: 4.254
Authors: R J Blendon; M Brodie; J M Benson; D E Altman; L Levitt; T Hoff; L Hugick Journal: Health Aff (Millwood) Date: 1998 Jul-Aug Impact factor: 6.301
Authors: Jessica D Bellinger; Heather M Brandt; James W Hardin; Shalanda A Bynum; Patricia A Sharpe; Dawnyéa Jackson Journal: Womens Health Issues Date: 2013-05-27
Authors: Garth Funston; Marije Van Melle; Marie-Louise Ladegaard Baun; Henry Jensen; Charles Helsper; Jon Emery; Emma J Crosbie; Matthew Thompson; Willie Hamilton; Fiona M Walter Journal: BMC Cancer Date: 2019-11-01 Impact factor: 4.430
Authors: Nkengafac Villyen Motaze; Primus Che Chi; Pierre Ongolo-Zogo; Jean Serge Ndongo; Charles S Wiysonge Journal: Cochrane Database Syst Rev Date: 2021-02-22