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May 20, 1988, Vol 259, No. 19 >
ARTICLE | May 20, 1988

Reverse Targeting of Preventive Care due to Lack of Health Insurance FREE

Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
[+] Author Affiliations

Reprint requests to Division of Social and Community Medicine, The Cambridge Hospital, 1493 Cambridge St, Cambridge, MA 02139 (Dr Woolhandler).


JAMA. 1988;259(19):2872-2874. doi:10.1001/jama.1988.03720190040028
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References

We analyzed patterns of receipt of preventive services among middle-aged women, with particular attention to health insurance coverage, based on data from the National Health Interview Survey. Lack of insurance was most prevalent among socioeconomically disadvantaged women at high risk for disease and was the strongest predictor of failure to receive screening tests. The relative risk of inadequate screening for uninsured compared with insured women was 1.60 (95% confidence interval [CI], 1.40 to 1.83) for blood pressure checkups, 1.55 (95% CI, 1.43 to 1.68) for cervical smears, 1.52 (95% CI, 1.41 to 1.63) for glaucoma testing, and 1.42 (95% CI, 1.33 to 1.51) for clinical breast examination. Controlling for demographic and health status variables did not diminish the effect of insurance coverage. We conclude that inadequate insurance coverage leads to "reverse targeting" of preventive care—that is, populations at highest risk are least likely to be screened. This compromises both the effectiveness and the cost-effectiveness of screening.

(JAMA 1988;259:2872-2874)

REFERENCES

1 +
Frame PS, Carlson SJ:  A critical review of periodic health screening using specific screening criteria. J Fam Pract 1975;;2:29-33, 123-129, 189-194, 283-289.
2 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination. Can Med Assoc J 1979;;121:1193-1254.
3 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination: II. 1985 update. Can Med Assoc J 1986;;134;724-727.
4 +
Goldbloom R, Battista RN:  The periodic health examination: Introduction. Can Med Assoc J 1986;;134:721-723.
5 +
American Cancer Society:  Guidelines for the cancer-related check-up: Recommendations and rationale. CA 1980;;30:194-240.
6 +
Current Estimates From the NHIS, 1982 , Vital and Health Statistics series 10, No. 150, DHHS publication (PHS) 85-1578. National Center for Health Statistics, 1985;.
7 +
Kovar MG, Poe GS: The NHIS Design, 1973 to 1984, and Procedures, 1975 to 1983 , Vital and Health Statistics series 1, No. 12, DHHS publication (PHS) 85-1320. National Center for Health Statistics, 1985;.
8 +
SAS User's Guide: Statistics , ed 5. Cary, NC, SAS Institute, 1984;.
9 +
Bloom B: Use of Selected Preventive Care Procedures: United States, 1982 , Vital and Health Statistics series 10, No. 157, DHHS publication (PHS) 86-1585. National Center for Health Statistics, 1986;.
10 +
Kleinman JC, Kopstein A:  Who is being screened for cervical cancer? Am J Public Health 1981;;71:73-76.
11 +
Connell FA, Diehr P, Hart LG:  The use of large data bases in health care studies. Ann Rev Public Health 1987;;8:51-74.
12 +
Gemson DH, Elinson J:  Prevention in primary care: Variability in physician practice patterns in New York City. Am J Prev Med 1986;;2:226-234.
13 +
Hayward RA, Shapiro MJ, Corey CR, et al: Who gets preventive care? Results from a new national survey. Read before the Society for General Internal Medicine, San Diego, May 1,1987.
14 +
Dawson DA, Henderschott GE, Bloom B:  Trends in routine screening examinations. Am J Public Health 1987;;77:1004-1005.
15 +
Lurie N, Manning WG, Peterson C, et al:  Preventive care: Do we practice what we preach? JAMA 1987;;77:801-804.
16 +
 Subcommittee on Cancer in the Economically Disadvantaged : Cancer in the Economically Disadvantaged: A Special Report . New York, American Cancer Society, 1986;.
17 +
Rudov MH, Santangelo N: Health Status of Minorities and Low Income Groups , publication (HPA 79-627). Dept of Health, Education, and Welfare, 1979;.
18 +
Bassett MT, Krieger N:  Social class and black-white differences in breast cancer survival. Am J Public Health 1986;;76:1400-1403.
19 +
Mandelblatt JS, Gopaul L, Wistreich M:  Gynecological care of elderly women: Another look at Papanicolaou smear testing. JAMA 1986;;256:367-371.
20 +
Bobrow RS:  Colorectal cancer at a public health center. JAMA 1987;;257:782-783.
21 +
Rabb MF:  Ophthalmology: Glaucoma , in Williams RA (ed): Textbook of Black-Related Disease . New York, McGraw-Hill International Book Co, 1975;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Frame PS, Carlson SJ:  A critical review of periodic health screening using specific screening criteria. J Fam Pract 1975;;2:29-33, 123-129, 189-194, 283-289.
2 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination. Can Med Assoc J 1979;;121:1193-1254.
3 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination: II. 1985 update. Can Med Assoc J 1986;;134;724-727.
4 +
Goldbloom R, Battista RN:  The periodic health examination: Introduction. Can Med Assoc J 1986;;134:721-723.
5 +
American Cancer Society:  Guidelines for the cancer-related check-up: Recommendations and rationale. CA 1980;;30:194-240.
6 +
Current Estimates From the NHIS, 1982 , Vital and Health Statistics series 10, No. 150, DHHS publication (PHS) 85-1578. National Center for Health Statistics, 1985;.
7 +
Kovar MG, Poe GS: The NHIS Design, 1973 to 1984, and Procedures, 1975 to 1983 , Vital and Health Statistics series 1, No. 12, DHHS publication (PHS) 85-1320. National Center for Health Statistics, 1985;.
8 +
SAS User's Guide: Statistics , ed 5. Cary, NC, SAS Institute, 1984;.
9 +
Bloom B: Use of Selected Preventive Care Procedures: United States, 1982 , Vital and Health Statistics series 10, No. 157, DHHS publication (PHS) 86-1585. National Center for Health Statistics, 1986;.
10 +
Kleinman JC, Kopstein A:  Who is being screened for cervical cancer? Am J Public Health 1981;;71:73-76.
11 +
Connell FA, Diehr P, Hart LG:  The use of large data bases in health care studies. Ann Rev Public Health 1987;;8:51-74.
12 +
Gemson DH, Elinson J:  Prevention in primary care: Variability in physician practice patterns in New York City. Am J Prev Med 1986;;2:226-234.
13 +
Hayward RA, Shapiro MJ, Corey CR, et al: Who gets preventive care? Results from a new national survey. Read before the Society for General Internal Medicine, San Diego, May 1,1987.
14 +
Dawson DA, Henderschott GE, Bloom B:  Trends in routine screening examinations. Am J Public Health 1987;;77:1004-1005.
15 +
Lurie N, Manning WG, Peterson C, et al:  Preventive care: Do we practice what we preach? JAMA 1987;;77:801-804.
16 +
 Subcommittee on Cancer in the Economically Disadvantaged : Cancer in the Economically Disadvantaged: A Special Report . New York, American Cancer Society, 1986;.
17 +
Rudov MH, Santangelo N: Health Status of Minorities and Low Income Groups , publication (HPA 79-627). Dept of Health, Education, and Welfare, 1979;.
18 +
Bassett MT, Krieger N:  Social class and black-white differences in breast cancer survival. Am J Public Health 1986;;76:1400-1403.
19 +
Mandelblatt JS, Gopaul L, Wistreich M:  Gynecological care of elderly women: Another look at Papanicolaou smear testing. JAMA 1986;;256:367-371.
20 +
Bobrow RS:  Colorectal cancer at a public health center. JAMA 1987;;257:782-783.
21 +
Rabb MF:  Ophthalmology: Glaucoma , in Williams RA (ed): Textbook of Black-Related Disease . New York, McGraw-Hill International Book Co, 1975;.

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