Women's use of preventive screening services: A comparison of HMO versus fee-for-service enrollees

Health maintenance organizations (HMOs) may relax some of the institutional barriers to using preventive screening services by requiring only a nominal copayment for such services and by promoting their use via educational programs. However, the gatekeeper system employed by HMOs may discourage the use of these services if referrals are required to access them. Using the 1987 National Medical Expenditure Survey and the 1992 National Health Interview Survey, the authors investigate whether HMO enrollment is associated with the use of preventive screening services for nonelderly, privately insured women. Employing models that control for self-selection into HMOs, the authors find that women who were enrolled in HMOs in 1987 were more likely to have received Pap smears and breast exams within the last year and to have ever received a mammogram when compared with women with fee-for-service coverage. By 1992, however, HMOs had lost this comparative advantage.