McKinney M M, Marconi K M
Bureau of Health Resources Development, Health Resources and Services Administration, Rockville, MD 20857.
J Community Health. 1992 Dec;17(6):333-49. doi: 10.1007/BF01323996.
Although numerous studies have established that breast cancer mortality can be significantly reduced through early detection, only a small percentage of women obtain screening mammograms at intervals recommended by the National Cancer Institute, the American Cancer Society, and other major medical organizations. This paper examines the importance of cost as a barrier to routine screening and the state legislative movement to make screening mammography a basic health insurance benefit. Mammography "knowledge, attitudes, and behavior" studies offer conflicting findings on the extent to which cost enters into the decision to have a mammogram. Women seldom report cost as a major reason for postponing or failing to have a mammogram; yet, descriptive studies show a consistently positive relationship between income and mammography use. State mammography reimbursement laws vary greatly with respect to whether screening mammography is a required or optional benefit, payment limits, and eligibility and referral requirements. Although state-specific data on the percentage of women with private health insurance are not available, 1987 National Medical Expenditure Survey estimates for U.S. Census geographic divisions suggest that the New England, East North Central, West North Central, Middle Atlantic, and Mountain states have the highest percentages of women who are privately-insured and, thus, potentially eligible for legislated mammography benefits. Access to screening mammography also is likely to be influenced by the proportion of employer-sponsored health plans that are self-insured and, therefore, exempt from minimum benefit mandates and the extent to which women are aware of the screening coverage.
尽管众多研究已证实，通过早期检测可显著降低乳腺癌死亡率，但只有一小部分女性按照美国国家癌症研究所、美国癌症协会及其他主要医学组织建议的间隔时间进行乳腺钼靶筛查。本文探讨了费用作为常规筛查障碍的重要性，以及将乳腺钼靶筛查纳入基本医疗保险福利的州立法动向。关于费用在多大程度上影响进行乳腺钼靶检查决策的“知识、态度和行为”研究结果相互矛盾。女性很少将费用作为推迟或不进行乳腺钼靶检查的主要原因；然而，描述性研究表明收入与乳腺钼靶检查的使用之间始终存在正相关关系。各州的乳腺钼靶报销法律在筛查乳腺钼靶检查是必需福利还是可选福利、支付限额以及资格和转诊要求等方面差异很大。虽然没有各州关于拥有私人医疗保险女性比例的具体数据，但1987年美国国家医疗支出调查对美国人口普查地理区域的估计表明，新英格兰、东中北部、西中北部、大西洋中部和山区各州拥有私人保险的女性比例最高，因此有可能符合立法规定的乳腺钼靶检查福利资格。获得乳腺钼靶筛查的机会也可能受到雇主赞助的自保健康计划比例的影响，这些计划因此不受最低福利要求的约束，以及女性对筛查覆盖范围的知晓程度。
