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ACA out-of-pocket cost reductions increased mammography, but not colonoscopy screenings
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After implementation of the Affordable Care Act’s elimination of copayments for screening colonoscopy and mammography in Medicare beneficiaries, screening rates for colonoscopy did not increase, while those for mammography did, according to recent study data.
“It was long assumed that cost was a major prohibitive factor for why people didn’t get screened. So the Affordable Care Act made an effort to reduce or remove costs for several highly successful screening and recommended procedures, including mammography and colonoscopy,” Gregory Cooper, MD, co-program leader for cancer prevention and control, UH Siedman Cancer Center and professor, Case Western Reserve University School of Medicine, said in a press release. “This data shows that doing so still doesn’t necessarily guarantee the patients who should be screened will be. Other factors clearly play a role and need to be addressed as well.”
To test the hypothesis that the ACA’s removal of copayments and coinsurance would increase rates of screening or surveillance colonoscopy and mammography, Cooper and colleagues used a national sample of Medicare claims data to compare procedure uptake among individuals aged 70 years or older before (2009-2010) and after ACA implementation (2011-2012). The mammography sample included 862,267 women and the colonoscopy sample included 326,503 individuals with high risk for colorectal cancer.
They found mammography uptake increased after the ACA was implemented; multivariable odds ratios (mORs) were 1.22 (95% CI, 1.2-1.25) for 2011, 1.17 (95% CI, 1.15-1.2) for 2012, and 1.03 (95% CI, 1.01-1.05) for 2010 compared with 2009. Younger age, lower comorbidity and previous mammography and preventive health visits were associated with increased use of mammography.
However, screening or surveillance colonoscopy uptake decreased in 2012 compared with 2009 (mOR = 0.95; 95% CI, 0.92-0.98), and did not significantly change in 2010 or 2011. There was a slight increase in colonoscopy receipt in 2011 (mOR = 1.07; 95% CI, 1.02-1.12) when analysis was restricted to patients aged 70 to 74 years. Younger age, male sex, lower comorbidity and previous preventive health visits were associated with increased use of colonoscopy.
“This study reinforces that we need to do more than simply issue national guidelines for colorectal cancer screening and make them affordable for everyone in the target population,” Cooper said in the press release. “It is imperative we find a way to increase participation in these important cancer screenings for at-risk populations. For example, if more people had yearly preventive visits, primary care physicians would have additional opportunities to emphasize the importance of procedures such as colonoscopy at detecting and treating cancer early.” – by Adam Leitenberger
Disclosures: This work was supported by the American Cancer Society, the Case Clinical and Translational Scientific Collaborative, National Center for Advancing Translational Sciences at the NIH, the Case Comprehensive Cancer Center, the National Cancer Institute at the NIH and the Cleveland Digestive Disease Research Core Center.
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