Figure 3.1

Distribution of women with breast cancer by disease stage at time of diagnosis.

Source: Hoffman, 1998.

Insurance policies vary in the extent of coverage they offer for cancer screening. People covered by plans with no or low levels of cost sharing are more likely to be screened for cancer than those in plans with higher out-of-pocket costs (Lurie et al., 1987). Among Medicare beneficiaries, those with private supplemental insurance are more likely to be screened for cancer than beneficiaries with Medicare supplemented by Medicaid or with Medicare alone (Blustein, 1995; Potosky et al., 1998). Cancer screening tests were a covered benefit for Medicare beneficiaries, but until 1998 a copayment was required for these tests.

The way health care is delivered also affects the use of cancer screening tests. Individuals covered by managed care plans have higher rates of cancer screening than those covered by fee-for-service plans (Burack and Gimotty, 1997; Potosky et al., 1998). This is true also of Medicare beneficiaries in HMOs, whose cancer screening rates are the highest of the elderly population (Potosky et al., 1998).

Even for those with insurance, screening tests may be inaccessible because there are no facilities within a reasonable distance. Perhaps for this reason, residents of rural areas use cancer screening tests less often than their urban counterparts (Hayward et al., 1988b; Katz and Hofer, 1994). Some specific findings include the following:

• Women living in areas with no or few mammogram facilities are less likely to have mammograms than those living in areas with more facilities (Mandelblatt, 1995).