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Issues of copayment found in older mammography patients
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The requirement of a copayment may decrease the rates of screening mammography among women, according to a recent data.
From 2001 to 2004, researchers from Brown University, the Providence Veterans Affairs Medical Center and Harvard School of Public Health compared rates of biennial breast cancer screening in care plans that involved copayments for mammography with rates for screening in plans that offered complete patient coverage.
The researchers studied mammography coverage in 174 Medicare managed-care plans.
The amount of plans using copayment increased between 2001 and 2004 from three to 21. Reported data showed that rates of screening declined 5.5 percentage points in plans that established copayments and increased 3.4 percentage points in plans that preserved complete coverage. A decrease of 8.3 percentage points in biennial screening rates was found in copayment plans compared with complete coverage plans and was intensified in patients with a lower education or income. – by Paul Burress
N Engl J Med. 2008;358:375-383.
This is a well-designed study examining screening mammography use by female enrollees in Medicare managed-care plans, aged 65 to 69 years. Studying the effects of cost sharing upon screening mammography in this way is particularly illuminating because mammography is known to reduce breast cancer mortality rates in this population. The study’s findings are striking, indicating that requiring patients to share in paying the costs of mammography services results in lower rates of use of this important, effective screening technique, especially among women residing in areas of lower income or educational levels. Dishearteningly, the study results showed that the prevalence of cost sharing for mammography increased substantially during the years studied. As the researchers found, the elderly may be particularly sensitive to even small copayments if they are on fixed incomes. Therefore, ironically, cost-sharing policies appear to be decreasing use of mammography in a population in whom it has proven benefits. Although cost sharing may be useful in reducing the level of over-utilized services, when applied too broadly, it may be both ethically unacceptable and financially inefficient, reducing the appropriate utilization of critical, cost-effective services. I agree wholeheartedly with the researchers that for effective services such as mammography, exemptions to cost sharing would be appropriate.
– Reshma Jagsi, MD, PhD
Assistant Professor, Department of Radiation Oncology, University of Michigan