Direct Access To OB/GYNs Fails To Improve Cancer Screening Rates

Main Category: Women's Health / Gynecology
Also Included In: Cancer / Oncology;  Breast Cancer
Article Date: 30 Oct 2006 - 0:00 PDT

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Laws requiring managed-care plans to allow women direct access to obstetricians or gynecologists have failed to increase screening rates for breast and cervical cancer, according to a new study.

Proponents of such laws had argued that they could improve women's health by increasing use of preventive tests. The study appears in the current issue of Health Services Research.

"Good health care requires much more than having these laws in place," said lead author Laurence Baker, Ph.D., of the Center for Health Policy at Stanford University. "It has a lot to do with people finding providers that they're comfortable with, knowing what they want and having providers be informed."

In the 1990s, many states adopted patient-protection regulations in response to the restrictive practices of managed-care plans. One common approach was to pass laws allowing women to visit obstetricians or gynecologists without a referral from their primary care physicians.

By 2001, 42 states plus the District of Columbia had passed some form of ob/gyn direct access law. The laws do not apply to women covered by public-sector health plans such as Medicaid and Medicare.

Baker and co-author Jia Chan, also of Stanford University, set out to compare health-care utilization among privately insured women before and after passage of direct-access legislation in various states. The pair analyzed data collected from 1996 to 2000 during telephone surveys coordinated by the Centers for Disease Control and Prevention.

Their samples included 189,840 women ages 18 to 64 for analysis of Pap tests and 100,140 women ages 40 to 64 for mammography. They used advanced statistical methods to adjust for various characteristics of individuals and states.

The found "no evidence for a strong or consistent relationship" between direct-access legislation and screening rates for breast or cervical cancer, according to the study.

"Maybe direct-access legislation isn't the right way to go about this at all," said Baker. "Consumer and provider education may be better ways of improving population health." Covering preventive care for uninsured individuals is also key, he added.

Health Services Research is the official journal of the AcademyHealth and is published by Blackwell Publishing on behalf of the Health Research and Educational Trust. HSR is available online at www.blackwell-synergy.com/loi/hesr.

Baker LC, Chan J. Laws requiring health plans to provide direct access to obstetricians and gynecologists, and use of cancer screening by women. Health Services Research (online), 2006.