Objective To assess the impact of screening on the incidence of and mortality from cervical cancer.

Since the introduction of screening there have been pronounced increases in recorded incidence in the screened age group. Cancer registries have an essential role in assessing screening programmes and cancer services. The steep decrease in mortality in 55-69 year olds which began three years after screening started is unlikely to be due to screening. The widespread adoption of treatment with tamoxifen during this period may be important. With the reduction in mortality already observed and the expected additional benefits from screening, the Health of the Nation target should be achieved.

Background Though the Affordable Care Act has been successful in expanding Medicaid to more than 17 million people, insurance alone may not translate into access to healthcare. Even among the insured, substantial barriers to accessing services inhibit healthcare utilization. Objectives We examined the effect of selected barriers to healthcare access and the magnitude of those barriers on healthcare utilization. Research Design Data come from a 2008 survey of adult enrollees in Minnesota’s public health care programs. We used multivariate logistic regression to estimate the effects of perceived patient, provider, and system-level barriers on past year delayed, foregone, and lack of preventive care. Subjects A total of 2,194 adults enrolled in Minnesota Health Care Programs who were mostly female (66%), high school graduates (76%), unemployed (62%), and living in metro areas (67%) were included in the analysis. Results Reporting problems across all barriers increased the odds of delayed care from two times for provider-related barriers (OR = 2.0, 95% CI: 1.2–3.3) to more than six times for access barriers (OR = 6.2, 95% CI: 3.8–10.2) and foregone care from 2.6 times for family/work barriers (OR = 2.6, 95% CI: 1.3–5.1) to more than seven times for access barriers (OR = 7.1, 95% CI: 3.9–13.1). Perceived discrimination was the only barrier consistently associated with all three utilization outcomes. Conclusions Multiple types of barriers are associated with delayed and foregone care. System-level barriers and discrimination have the greatest effect on healthcare seeking behavior.

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