The importance of health insurance as a determinant of cancer screening: Evidence from the women's health initiative

Judith Hsia*, Elizabeth Kemper, Catarina Kiefe, Jane Zapka, Shoshanna Sofaer, Mary Pettinger, Deborah Bowen, Marian Limacher, Linda Lillington, Ellen Mason

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

218 Scopus citations


Background. Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initiative Observational Study cohort. Methods. Questionnaire data from 55,278 women enrolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. Results. Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. Conclusions. In the Women's Health Initiative Observational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening independent of demographics, chronic health conditions, and self-perceived health characteristics. (C) 2000 American Health Foundation and Academic Press.

Original languageEnglish (US)
Pages (from-to)261-270
Number of pages10
JournalPreventive medicine
Issue number3
StatePublished - 2000
Externally publishedYes


  • Health services accessibility
  • Insurance coverage
  • Neoplasm/prevention and control

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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