Address correspondence to Kathryn A. Phillips, Ph.D., Associate Professor of Health Services Research and Health Economics, School of Pharmacy, Institute of Health Policy Studies, and UCSF Comprehensive Cancer Center, University of California, San Francisco, 3333 California St., Suite 420, Box 0613, San Francisco, CA 94143. Jennifer S. Haas, M.D., M.S.P.H., Su-Ying Liang, Ph.D., Sherilyn Tye Ph.D., Julie Sakowski, Ph.D., Joanne Spetz, Ph.D., are with the University of California, San Francisco. Laurence C. Baker, Ph.D., is with Stanford University. Karla Kerlikowske, M.D., is with the University of California, San Francisco, Department of General Internal Medicine, VAMC.
Are Gatekeeper Requirements Associated with Cancer Screening Utilization?
Version of Record online: 6 JAN 2004
Health Services Research
Volume 39, Issue 1, pages 153–178, February 2004
How to Cite
Phillips, K. A., Haas, J. S., Liang, S.-Y., Baker, L. C., Tye, S., Kerlikowske, K., Sakowski, J. and Spetz, J. (2004), Are Gatekeeper Requirements Associated with Cancer Screening Utilization?. Health Services Research, 39: 153–178. doi: 10.1111/j.1475-6773.2004.00220.x
This work was supported by funding to Dr. Phillips from the National Cancer Institute (R01 CA81130). Partial support was also provided by the Agency for Healthcare Research and Policy (P01 HS10771 and P01 HS 10856).
- Issue online: 6 JAN 2004
- Version of Record online: 6 JAN 2004
- cancer screening;
- health insurance;
- managed care
Objective. There is widespread debate over whether health plans should require enrollees to use “gatekeepers,” which are primary care providers that coordinate care and control access to specialists. However, little is known about whether health plan gatekeeper requirements improve or reduce quality-of-care. Our objective was to examine whether gatekeeper requirements are associated with the utilization of cancer screening for breast, cervical, and prostate cancer.
Data Sources. Three linked sources (N=13,534): (1) 1996 Medical Expenditure Panel Survey (MEPS) Household Survey, a nationally representative, ongoing survey sponsored by the Agency for Healthcare Research and Quality; (2) 1996 MEPS Health Insurance Plan Abstraction, which codes data from health plan booklets obtained from privately insured respondents, and (3) 1995 National Health Interview Survey.
Study Design/Data Collection. Cross-sectional, multivariate logistic regression analysis using secondary data.
Principal Findings. We found in multivariate analyses that women in gatekeeper plans were significantly more likely to obtain mammography screening (Odds Ratio [OR]=1.22, 95 percent Confidence Interval [CI] 1.07–1.40), clinical breast examinations (OR=1.39, 95 percent CI 1.23–1.57), and Pap smears (OR=1.33, 95 percent CI 1.16–1.52) than women not in gatekeeper plans. In contrast, gatekeeper requirements were not associated with prostate cancer screening (OR=1.11, 95 percent CI 0.93–1.33). We found no association between screening utilization and aggregate plan types (HMO, POS, PPO, FFS).
Conclusions. Gatekeeper requirements are associated with higher utilization of widely recommended cancer screening procedures, but not with utilization of a less uniformly recommended cancer screening procedure. Researchers should consider the analysis of specific plan characteristics rather than aggregate plan types in conducting future research, and insurers and policymakers should consider the potential benefits of gatekeepers with respect to preventive care when designing health plans and legislation.