Potosky A L, Breen N, Graubard B I, Parsons P E
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.
Med Care. 1998 Mar;36(3):257-70. doi: 10.1097/00005650-199803000-00004.
The authors investigated whether utilization of six different cancer screening tests (mammography, clinical breast exam, Pap smear, Fecal Occult Blood Test, and Digital rectal exam) varied according to type of health care coverage.
Data on the use of cancer screening tests and coverage in two age groups from a 1992 nationally representative cross-sectional survey of approximately 9,400 adults were analyzed. Multiple logistic regression analysis was used to estimate proportions of persons screened according to type and extent of coverage, adjusted for socioeconomic, demographic, and health status characteristics.
Persons aged 40 to 64 years with Medicaid coverage were equally as likely to receive five of six cancer screening tests as those with private fee-for-service coverage, and both groups were much more likely to be screened (70% higher for all six tests) than those who had no coverage. In contrast, persons aged 65 years and older who had supplemental private fee-for-service insurance in addition to Medicare were more likely to receive five of six tests than those with Medicare and Medicaid or those with Medicare only. For all six screening tests, managed care enrollees at all ages were approximately 10% more likely to be screened than persons enrolled in private fee-for-service plans. Fecal Occult Blood Test (25% versus 20%) and digital rectal exams (44% versus 38%) in persons aged 40 to 64 years and mammography (59% versus 48%) and Fecal Occult Blood Test screening (38% versus 30%) in the elderly were significantly more frequent for persons in managed care plans.
The extent of fee-for-service insurance coverage in the traditional indemnity US health care system was positively associated with the use of cancer screening tests. The authors found less difference in use of cancer screening between managed care and fee-for-service care in 1992 than we expected based on earlier research comparing use of preventive services in health maintenance organizations with fee-for-service care.
作者调查了六种不同癌症筛查测试（乳房X光检查、临床乳房检查、巴氏涂片检查、粪便潜血试验和直肠指检）的使用情况是否因医保类型而异。
分析了1992年一项对约9400名成年人进行的全国代表性横断面调查中两个年龄组的癌症筛查测试使用情况和医保覆盖数据。采用多元逻辑回归分析来估计根据医保类型和覆盖范围进行筛查的人群比例，并对社会经济、人口统计学和健康状况特征进行了调整。
40至64岁有医疗补助保险的人群接受六项癌症筛查测试中的五项的可能性与有私人按服务付费保险的人群相同，而且这两组接受筛查的可能性都比没有医保的人群高得多（六项测试的可能性均高出70%）。相比之下，65岁及以上除医疗保险外还有补充私人按服务付费保险的人群接受六项测试中的五项的可能性高于有医疗保险和医疗补助保险的人群或仅参加医疗保险的人群。对于所有六项筛查测试，各年龄段参加管理式医疗的参保者接受筛查的可能性比参加私人按服务付费计划的参保者高约10%。40至64岁人群中，管理式医疗计划的人群进行粪便潜血试验（25%对20%）和直肠指检（44%对38%）的频率明显更高，老年人中进行乳房X光检查（59%对48%）和粪便潜血试验筛查（38%对30%）的频率明显更高。
美国传统赔偿型医疗体系中按服务付费保险的覆盖范围与癌症筛查测试的使用呈正相关。作者发现，1992年管理式医疗和按服务付费医疗在癌症筛查使用方面的差异比我们根据早期将健康维护组织中预防性服务的使用与按服务付费医疗进行比较的研究所预期的要小。
