A recent article in the New England Journal of Medicine reports that cost sharing among Medicare patients may discourage women from getting important preventive healthcare such as screening mammograms.
A mammogram is an X-ray image of the breast that can reveal irregularities and help detect cancer early when it is most treatable. A screening mammogram is a mammogram performed on a woman with no signs or symptoms of breast cancer. Currently, the National Cancer Institute recommends that women age 40–49 have screening mammograms every 1–2 years, depending on their individual risk for breast cancer. For women 50 years and older, it is recommended that screening mammograms be performed every 1–2 years.
Cost sharing, or co-payments, is common in Medicare managed healthcare plans. For Medicare patients, however, even small co-payments may impact their healthcare practices.
In this recent study, researchers reviewed coverage in 174 Medicare managed care plans between the years of 2001–2004. Within these plans 550,082 individual level observations for 366,475 women age 65–69 were evaluated. A comparison of breast cancer screening was performed between plans requiring cost sharing for mammography and plans with full coverage for screening mammography. Additional analysis evaluated the rates of screening mammograms among plans that changed from full coverage to a cost sharing program and compared them against plans that did not institute cost sharing. For the purpose of this study, researchers defined cost sharing as a co-payment of more than $10 or coinsurance of more than 10% for screening mammography.
- Results of the study found that between 2001 and 2004 healthcare plans requiring co-payments or coinsurance increased from three in 2001 (affecting 0.5% of women) to 21 in 2004 (affecting 11.4% of women).
- Every-two-year screening rates were 8.3% lower among women with cost-sharing plans when compared with plans providing full coverage for mammography. This effect was even more apparent among women residing in lower income areas and for women with lower educational levels.
- Among the plans that shifted from full coverage to cost sharing, screening rates dropped 5.5%, although rates increased 3.4% among the plans that maintained full coverage.
Researchers concluded that even small co-payments affect the rate at which women undergo screening mammography. For effective preventive services such as mammography to be followed according to clinical guidelines, exempting elderly adults from cost sharing may be a consideration.
Reference: Trivedi, A., Rakowski, W., Ayanian, J., Effect of cost sharing on screening mammography in Medicare health plans. New England Journal of Medicine. 2008. 358: 375-383.