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Health Care Costs and Financing

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Health plan use of gatekeepers may improve use of recommended cancer screening

There is widespread debate over whether health plans should require enrollees to use "gatekeepers," primary care providers who coordinate care and control access to specialists. Opponents believe these gatekeepers restrict access to care. However, a recent study found an increase in recommended cancer screening among women enrolled in gatekeeper plans. These women had 22 percent higher odds of obtaining mammography screening, 39 percent higher odds of having a clinical breast examination, and 33 percent higher odds of having a Pap smear than women not in gatekeeper plans. In contrast, gatekeeper requirements were not associated with prostate cancer screening among men, which is less uniformly recommended.

There was no association between screening use and plan type (health maintenance organization, point of service, preferred provider organization, and fee-for-service). Insurers and policymakers should consider the potential benefits of gatekeepers with respect to preventive care when designing health plans and legislation, suggest the University of California, San Francisco, researchers who conducted the study. Their work was supported in part by the Agency for Healthcare Research and Quality (HS10771 and HS10856).

The researchers linked three data sources to examine whether gatekeeper requirements were associated with use of cancer screening for breast, cervical, and prostate cancer. The sources included the 1996 Medical Expenditure Panel Survey (MEPS) Household Survey, a nationally representative, ongoing survey; the 1996 MEPS Health Insurance Plan Abstraction, which codes data from health plan booklets obtained from privately insured respondents, and the 1995 National Health Interview Survey.

For details, see "Are gatekeeper requirements associated with cancer screening utilization?" by Kathryn A. Phillips, Ph.D., Jennifer S. Haas, M.D., M.S.P.H., Su-Ying Liang, Ph.D., and others, in the February 2004 Health Services Research 39(1), pp. 153-178.

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