SCREENING FOR CANCER AND MARKET STRUCTURE:A MULTILEVEL ANALYSIS FOR MAMMOGRAM AND PAP-SMEAR UTILIZATION IN THE U.S.

This paper investigates the relationship between health care market structure and utilization of preventive care services, namely mammogram and Papanicolaou (Pap-smear) screening. In addition to their life saving aspects, it is always believed that preventive health care services are important due to their cost-effectiveness which would prevail under managed competition. Yet, the nature of managed competition has been changing as a result of the backlash against it since the mid-1990s. We have yet to provide a clear answer to the question of how market structure affects the utilization of preventive care in general, and how the latest changes in health care market have been affecting it. These are the primary research questions of the paper. These research questions are answered by employing a new methodology that has not been used before. A multilevel modeling technique is employed to study the impact of changes in the structure of health care market on the utilization of mammogram and Pap-smear tests. In addition, an unusual data source, insurance claims data, rather than surveys or discharge data, is used in this study.