Journal of Health Care for the Poor and Underserved

Brief communication 151 USE OF PREVENTIVE SERVICES IN A POPULATION OF VERY LOW-INCOME WOMEN For breast and cervical cancer, low-income women and women of color, compared with women in the general population, have been found to use screening less frequently, present with more advanced stages of disease, and have worse outcomes.1"10 Even among women who receive services through Medicaid and for whom female-specific preventive health care services are covered, the rates for receipt of these screening tests remain far below the goals set forth in Healthy People 2010.11 To reduce disparities in care for breast and cervical cancer screening, local and state governments have begun to design and implement low-cost and no-cost programs to provide primary health care services to poor adults who are eligible for various forms of public assistance but who are not eligible for Medicaid.12"17 The focus of many interventions has been to increase awareness of the importance of screening and to identify systems that allow women greater access to these important preventive services. Although the impact of cervical and breast cancer screening on the reduction of mortality has been well documented,18"22 limited information is available regarding the receipt of age- and gender-specific preventive services by very low-income women who do not receive Medicaid. These women may be at increased risk for not receiving preventive services due to financial barriers (e.g., lack of insurance)23,24 as well as nonfinancial barriers, including structural barriers to care (e.g., reliance on episodic care from emergency departments and urgent care facilities)25,26 and competing or conflicting needs (e.g., obtaining food, shelter, clothing).27,28 This study focuses on cancer screening rates among very low-income uninsured women in Los Angeles County who applied for and were deemed eligible to receive public assistance in the form of General Relief (a California financial assistance program). The study was performed just prior to the implementation of welfare reform at the state and national levels and provides baseline data for this population. This study provided an opportunity to assess baseline characteristics of patients prior to their enrollment in a publicly sponsored program for health care. The objectives of this study were (1) to measure receipt of age- and gender -appropriate preventive health care services (Pap smears and mammograms within one year) by very low-income women prior to their enrollment in Los Angeles County's health care program for very low-income adults, Received February 29,2000; revised March 2,2001; accepted May 23,2001. Journal of Health Care for the Poor and Underserved · Vol. 13, No. 2 · 2002 152 Use of Preventive Services (2) to assess whether racial/ethnic differences exist for receipt of preventive health care services in this sample, and (3) to identify other factors that may hinder impoverished women who do not have health insurance from receiving preventive services. Method The General Relief program is mandated by the state and implemented and financed by county governments to provide financial assistance to adults who are ineligible for federal or state financial subsidies. It provides financial assistance to very low-income adults who are ineligible for other welfare benefits (e.g., Aid to Families With Dependent Children [AFDC], Supplemental Security Income [SSI]). At the time of this study (in 1996), the monthly stipend for an individual General Relief recipient was $212, plus food stamps and medical coverage. Beginning in October 1995, at the time that an applicant was determined eligible for General Relief, beneficiaries were expected to meet with a health benefits representative (HBR) to learn about the General Relief Health Care Program (GRHCP). Although the women studied here were very poor, they were not eligible for Medicaid because they did not meet the categorical eligibility criteria for that program. As part of their meeting with the HBR, recipients received verbal instructions for the completion of a 31-item health history questionnaire developed and administered by the Los Angeles County Department of Health (as described below). We received permission to study and analyze the data obtained from the health history questionnaires and administrative records. Female subjects were included in our study if they had...