The health insurance market, labor unions, and utilization of cancer screening

The present study examines the effect of labor market characteristics, especially labor unions, on the use of two representative cancer screening services, namely the mammogram and the Pap smear, given the level of competition in the health insurance market. The role of labor unions is illustrated by means of estimated probabilities based on regression results that consider, for the first time, both health insurance and labor market variables in the same model by employing a multilevel analysis, a technique not previously used in prevention studies. The results suggest that competition among health insurance plans may actually reduce the use of preventive care whereas union membership may mitigate such negative impacts.