The effect of access on the utilization of preventive health services: The case of breast cancer screening in the military health care system

Background. Although breast cancer screenings, mammography and clinical breast examinations, are the most effective methods for detecting early breast cancer, many women underutilize these screening services. This study focuses on the breast cancer screening (BCS) practices among women eligible for care within the military health system (MHS). This study examines access to care, population, and satisfaction factors that may prevent women from timely BCS services.; Methods. Data from the 1998 Health Care Survey of Department of Defense (DoD) Beneficiaries (Form A) (HCSDB) and the 1998 American Hospital Association surveys were analyzed. Descriptive and bivariate statistics in addition to logistic regression models were used to examine the relationships between the dependent variable (BCS) and the independent variables in this study.; Results. The findings indicated that MHS women beneficiaries who utilized health resources in areas with small provider to military population ratios (<.690308) were significantly more likely to utilize breast cancer screening services than MHS women who utilized health resources in areas with large provider to military population ratios (>.1253919). MHS Women who were 40 to 49 years old were significantly less likely to use these services as compared with older women. Asian women were significantly less likely to use BCS services. Women with more education were significantly more likely to use BCS services than women with less education. MHS women beneficiaries who reported their health status as fair or poor were significantly more likely to use screening services compared with those in excellent health. MHS women users of civilian HMOs were more likely to use BCS services compared to users of military HMOs. Women who reported to have had a primary care manager were significantly more likely to use BCS services. Women who had to wait for 30 minutes or less for their clinical appointments were more likely to use BCS services. MHS women who reported to be more satisfied with their military treatment facility were more likely to use BCS services.; Conclusions. This study had identified important factors in explaining and predicting beneficiaries who are at greatest risk of not participating in breast cancer screening programs. All military branches of the services appear to provide relatively equal access and utilization to breast cancer screening programs. In contrast, provider to military population ratios, age, race, education, civilian HMOs, and certain access barriers are important predictors that appear to prevent MHS women from utilizing breast cancer screening programs in a military healthcare setting. (Abstract shortened by UMI.)...