When faced with even a modest health insurance co-payment for a mammogram, significantly fewer women receive these potentially life-saving breast cancer screenings, according to a new study by Brown University and Harvard Medical School researchers.
In this large-scale investigation of the relationship between health insurance co-payments and mammography rates, researchers found that screening rates were 8 percent lower among women with a co-payment than among women with full insurance coverage. Researchers at The Warren Alpert Medical School of Brown University, with a colleague from Harvard Medical School, publish their results in the current issue of the New England Journal of Medicine.
“The message is simple and it’s startling – a small co-payment for a mammogram can lead to a sharp decrease in breast cancer screening rates,” said Amal Trivedi, M.D., lead author of the study and assistant professor in the Department of Community Health at Alpert Medical School. “Co-payments as low as $12 deter women from getting mammograms. Because mammograms are critical in the fight against breast cancer, the most common cancer among American women, our findings have important health policy implications.”
“Eliminating co-payments for mammograms in the Medicare program has the potential to save lives, because screening detects breast cancers at an earlier, more curable stage,” said John Ayanian, M.D., study co-author and professor of medicine and health care policy at Harvard Medical School and Brigham and Women’s Hospital.
The effect of insurance co-payments, or consumer cost sharing, on health care use and spending is a topic of intense interest for health policy-makers and researchers. But recent long-term data on the consequences of cost sharing, like deductibles and co-pays are limited. For example, results of the RAND Health Insurance Experiment, a watershed study of cost sharing and its impact on health, were released in 1982.
Trivedi wanted to gather and analyze more recent data because cost sharing is on the rise. According to a 2006 survey by the Henry J. Kaiser Family Foundation and the Health Research and Educational Trust, the most common co-payment for a medical office visit has doubled since 2001 while deductibles have increased an average of 60 percent in employer-based plans.
Trivedi chose to study mammography because the benefits of these X-ray photographs of the breast are widely accepted. The American Cancer Society, for example, recommends that women over 40 get annual mammograms to increase the odds of early breast cancer detection and treatment. Trivedi chose Medicare managed-care health insurance plans for review because the team could study a large number of patients over time.
In their study, Trivedi and colleagues studied coverage for mammography within 174 Medicare managed-care plans from 2001 to 2004. The review included 366,475 women between the ages of 65 and 69 living in 38 states.
The team compared the rates of biennial breast cancer screening within plans requiring co-payments with screening rates for plans with full coverage. They also analyzed data from plans that introduced co-payments over the three-year study period in order to study how mammography rates would change compared to rates in plans without co-payments.
Trivedi and his team found that:
biennial breast cancer screening rates were 8 to 11 percent lower in cost-sharing plans – a difference that persisted even when adjusting for possible differences due to income, education, race and other factors;
from 2002 to 2004, screening rates decreased by 6 percent in plans that introduced co-payments while screening rates increased by 3 percent in matched control plans that retained full coverage;
the number of plans with cost sharing for mammography grew from three to 21 between 2001 and 2004, affecting .5 percent of women in 2001 and 11 percent of women by 2004;
in cost sharing plans, the range of co-payments for a mammogram was $12.50 to $35, with an average co-payment of $20.
“We’ve isolated the effect of co-payments on an important preventive health measure,” Trivedi said. “Mammograms are an essential service for older women, yet many women avoid that service when they are required to pay out-of-pocket. By eliminating co-payments for mammograms, we could get more women tested. More testing would mean earlier breast cancer treatment and improved chances for breast cancer survival.”
William Rakowski, a professor in the Department of Community Health at Brown and a senior investigator in the Center for Gerontology and Health Care Research, was part of the study team.
The Agency for Healthcare Research and Quality funded the work.
Wendy Lawton | EurekAlert!
Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung
Scientists reveal source of human heartbeat in 3-D
07.08.2017 | University of Manchester
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
23.08.2017 | Life Sciences
23.08.2017 | Life Sciences
22.08.2017 | Health and Medicine