Recession and high co-pays resulted in fewer colonoscopy screenings among the insured

Dorn SD. Clin Gastroenterol Hepatol.2012;10:278-284.

During the recession, continuously insured Americans underwent fewer colonoscopy screenings for colorectal cancer than expected based on use in the preceding 2 years, according to study findings published in Clinical Gastroenterology and Hepatology.

Prior studies revealed that many patients referred for colonoscopy failed to undergo the procedure because of high direct out-of-pocket costs, such as co-payment and co-insurance. Researchers in this study examined whether rates of screening colonoscopies in an insured population decreased during the economic recession.

They collected and analyzed administrative data from 106 health plans to determine monthly rates of screening colonoscopies performed on beneficiaries aged 50 to 64 years from 2005 to 2007, as well as from 2007 to 2009, representing periods before and during the recession. In addition, they used a segmented regression model to evaluate fluctuations in screening colonoscopy rates, as well as the association between screening and out-of-pocket costs.

The researchers identified 86,644 patients who underwent screening colonoscopies. They observed that the rates of screening colonoscopy increased before the recession (95% CI, 32.4-43.9) and then decreased during the recession (95% CI, –42.2 to –19.1). Based on prerecession trends, screening colonoscopy use declined at a rate of 68.9 (95% CI, –84.6 to –53.1) fewer colonoscopies per 1 million insured patients per month (P,.001) during the recession.

“Patients facing high out-of-pocket costs were less likely to undergo colonoscopy at any time point, especially during the recession,” researcher Spencer D. Dorn, MD, MPH, said in a press release. “Before the recession, these individuals were less likely to get a screening colonoscopy, but the gap in use between those with high and low out-of-pocket costs was narrowing. But when the recession hit full force, the discrepancy in use widened again.”

An extrapolation of the study results to the overall US population indicated that commercially insured patients aged 50 to 64 years underwent approximately 500,000 fewer screening colonoscopies during the recession. Compared with those with low out-of-pocket costs, those with high out-of-pocket procedure costs exhibited lower rates of screening before and during the recession and had a greater reduction in screening rates during the recession (P=.035).

“During the recent economic recession, the rates of screening colonoscopy decreased among insured Americans,” the researchers wrote. “Members of health plans with high colonoscopy [out-of-pocket] costs were less likely to undergo colonoscopy at all time points, and this differential use worsened during the recession. Thus, policies to reduce patient cost sharing for colonoscopy and other recommended, cost-effective preventive services should be considered.”

Disclosure: The researchers report no relevant financial disclosures.

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