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Educational level, voluntary private health insurance and opportunistic cancer screening among women in Catalonia (Spain).

Abstract Health care services in Catalonia (Spain) are organized in a national health service with universal population coverage and include preventive services such as mammography and Pap tests. In addition to a national health service (NHS) coverage, 22% of the population is enrolled in a voluntary private health insurance (VPHI), leading to a double coverage. This situation offers an opportunity to study the impact of this organizational aspect of health care with regard to cancer screening access. The source of data was the Catalan Health Survey (CHS), a cross-sectional survey conducted in a random sample of non-institutionalized population carried out in 1994. Variables analysed were age, educational level and voluntary private health insurance (VPHI). Women were asked if they had ever had a mammography and Pap test for preventive purposes. Logistic regression was used to study the relationship between these variables and the mammography or Pap test participation. The study sample was 5865 women aged 20 years and older. A Pap test and mammography were carried out on 42% and 25% of women, respectively. Participation had a peak between the ages of 30 and 39 years in Pap test and between 40 and 49 years in mammography; it decreased in older women. The percentage of Pap test practice increases according to a higher educational level than it does in mammography. Women who had a VPHI showed a higher percentage of screening tests than the rest of the population. There is also an increase in the mammography practice related to the educational level in older groups, but this fact is not observed in women younger than 40 years . Multivariate logistic regression analysis showed an increase in the likelihood of ever had a mammography and a Pap test according to age and to educational level, although this situation is less pronounced in older age groups. Both variables (educational level and age) remained significant after introducing the VPHI into the model (women who reported having a VPHI were more likely to have had a Pap test and a mammography than the rest of the women). In conclusion the opportunistic screening is associated with age, educational level and VPHI. Educational level is also associated with participation in both screening tests after adjusting by age. Furthermore, screening for cervical cancer shows a higher educational gradient than for breast cancer screening. The influence of VPHI after adjusting by age and by educational level poses the question about the role of private health insurances with regard to preventive practices in the context of a national health service aimed at promoting equity of health care access.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title european journal of cancer prevention : the official journal of the european cancer prevention organisation (ecp)
Publication Year Start




PMID- 10548398
OWN - NLM
STAT- MEDLINE
DA  - 19991206
DCOM- 19991206
LR  - 20051117
IS  - 0959-8278 (Print)
IS  - 0959-8278 (Linking)
VI  - 8
IP  - 5
DP  - 1999 Oct
TI  - Educational level, voluntary private health insurance and opportunistic cancer
      screening among women in Catalonia (Spain).
PG  - 427-34
AB  - Health care services in Catalonia (Spain) are organized in a national health
      service with universal population coverage and include preventive services such
      as mammography and Pap tests. In addition to a national health service (NHS)
      coverage, 22% of the population is enrolled in a voluntary private health
      insurance (VPHI), leading to a double coverage. This situation offers an
      opportunity to study the impact of this organizational aspect of health care with
      regard to cancer screening access. The source of data was the Catalan Health
      Survey (CHS), a cross-sectional survey conducted in a random sample of
      non-institutionalized population carried out in 1994. Variables analysed were
      age, educational level and voluntary private health insurance (VPHI). Women were 
      asked if they had ever had a mammography and Pap test for preventive purposes.
      Logistic regression was used to study the relationship between these variables
      and the mammography or Pap test participation. The study sample was 5865 women
      aged 20 years and older. A Pap test and mammography were carried out on 42% and
      25% of women, respectively. Participation had a peak between the ages of 30 and
      39 years in Pap test and between 40 and 49 years in mammography; it decreased in 
      older women. The percentage of Pap test practice increases according to a higher 
      educational level than it does in mammography. Women who had a VPHI showed a
      higher percentage of screening tests than the rest of the population. There is
      also an increase in the mammography practice related to the educational level in 
      older groups, but this fact is not observed in women younger than 40 years .
      Multivariate logistic regression analysis showed an increase in the likelihood of
      ever had a mammography and a Pap test according to age and to educational level, 
      although this situation is less pronounced in older age groups. Both variables
      (educational level and age) remained significant after introducing the VPHI into 
      the model (women who reported having a VPHI were more likely to have had a Pap
      test and a mammography than the rest of the women). In conclusion the
      opportunistic screening is associated with age, educational level and VPHI.
      Educational level is also associated with participation in both screening tests
      after adjusting by age. Furthermore, screening for cervical cancer shows a higher
      educational gradient than for breast cancer screening. The influence of VPHI
      after adjusting by age and by educational level poses the question about the role
      of private health insurances with regard to preventive practices in the context
      of a national health service aimed at promoting equity of health care access.
FAU - Borras, J M
AU  - Borras JM
AD  - Cancer Prevention and Control Unit, Institut Catala d'Oncologia, Spain.
      [email protected]
FAU - Guillen, M
AU  - Guillen M
FAU - Sanchez, V
AU  - Sanchez V
FAU - Junca, S
AU  - Junca S
FAU - Vicente, R
AU  - Vicente R
LA  - ENG
PT  - Journal Article
PL  - England
TA  - Eur J Cancer Prev
JT  - European journal of cancer prevention : the official journal of the European
      Cancer Prevention Organisation (ECP)
JID - 9300837
SB  - IM
MH  - Adult
MH  - Breast Neoplasms/*prevention & control
MH  - Cross-Sectional Studies
MH  - Educational Status
MH  - Female
MH  - Health Services Accessibility/*statistics & numerical data
MH  - Health Surveys
MH  - Humans
MH  - Insurance, Health/*economics
MH  - Logistic Models
MH  - Mammography/*utilization
MH  - Mass Screening/economics/*organization & administration/*utilization
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - National Health Programs/organization & administration
MH  - Patient Compliance
MH  - Sampling Studies
MH  - Socioeconomic Factors
MH  - Spain
MH  - Uterine Cervical Neoplasms/*prevention & control
MH  - Vaginal Smears/*utilization
EDAT- 1999/11/05
MHDA- 1999/11/05 00:01
CRDT- 1999/11/05 00:00
PST - ppublish
SO  - Eur J Cancer Prev. 1999 Oct;8(5):427-34.

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