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Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses


  • Marianne P. Bitler
  • Christopher S. Carpenter


We examine the effects of state health insurance mandates requiring coverage of screening mammograms. We find robust evidence that mammography mandates significantly increased mammography screenings by 4.5-25 percent. Effects are larger for women with less than a high school degree in states that ban deductibles, a policy similar to a provision of federal health reform that eliminates cost-sharing for preventive care. We also find that mandates increased detection of early stage in-situ pre-cancers. Finally, we find a substantial proportion of the increased screenings were attributable to mandates that are not consistent with current recommendations of the American Cancer Society.

Suggested Citation

  • Marianne P. Bitler & Christopher S. Carpenter, 2011. "Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses," NBER Working Papers 16669, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:16669
    Note: HC HE

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    Cited by:

    1. Itzik Fadlon & Torben Heien Nielsen, 2019. "Family Health Behaviors," American Economic Review, American Economic Association, vol. 109(9), pages 3162-3191, September.
    2. Scott Barkowski & Joanne Song McLaughlin & Alex Ray, 2020. "A Reevaluation of the Effects of State and ACA Dependent Coverage Mandates on Health Insurance Coverage," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(3), pages 629-663, June.
    3. Marianne Bitler & Lucie Schmidt, 2012. "Utilization of Infertility Treatments: The Effects of Insurance Mandates," Demography, Springer;Population Association of America (PAA), vol. 49(1), pages 125-149, February.
    4. Fabrice Smieliauskas & Hari Sharma & Connor Hurley & Jonas A. de Souza & Ya‐Chen Tina Shih, 2018. "State insurance mandates and off‐label use of chemotherapy," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 55-70, January.
    5. Price, Sarah & Zhang, Xiaohui & Spencer, Anne, 2020. "Measuring the impact of national guidelines: What methods can be used to uncover time-varying effects for healthcare evaluations?," Social Science & Medicine, Elsevier, vol. 258(C).
    6. Liran Einav & Amy Finkelstein & Tamar Oostrom & Abigail J. Ostriker & Heidi L. Williams, 2019. "Screening and Selection: The Case of Mammograms," NBER Working Papers 26162, National Bureau of Economic Research, Inc.
    7. Thomas C. Buchmueller & Léontine Goldzahl, 2018. "The effect of organized breast cancer screening on mammography use: Evidence from France," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 1963-1980, December.
    8. Kim, Hyuncheol Bryant & Lee, Sun-mi, 2017. "When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program," Journal of Health Economics, Elsevier, vol. 53(C), pages 100-116.

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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