Survey: 20% of women with high deductible would forgo testing after abnormal mammogram

One in five women with high-deductible health insurance plans who had an abnormal screening mammogram would opt out of follow-up testing, according to survey results presented at the Radiological Society of North America annual meeting.

“We noticed that some women were not showing up for diagnostic imaging at our imaging center in Boston Medical Center,” Michael Ngo, MD, a radiology resident at Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, told Healio. “We believed that the deductible payment associated with these imaging could be a contributing factor for the no-shows. Priscilla J. Slanetz, MD, MPH, one of the authors, was advocating for a legislation in Massachusetts that would eliminate the associated cost with diagnostic imaging if the patient had an abnormal screening mammogram. However, she needed evidence to support the claim that these out-of-pocket costs were a barrier to diagnostic imaging.”

Ngo and colleagues administered a survey to 932 participants who presented for breast imaging at their institution between September 2021 and February 2022. The survey collected data on demographics and patient attitudes in scenarios related to breast imaging.

Of 714 participants who responded to a question about whether they would skip indicated imaging if they knew they would have to pay a deductible, 151 (21.2%) said they would skip, 424 (59.4%) said they would not skip and 139 (19.5%) were undecided.

Additionally, 707 participants responded to a question asking whether they would skip an initial mammogram if they knew they would pay a deductible for follow-up testing. Of these, 129 (18.3%) said they would skip, 465 (65.8%) said they would not skip and 113 (16%) were undecided.

Among those reporting they would skip follow-up imaging were 33% of Hispanic participants, 31% of those with up to a high school education, 27% of those with an annual household income below $35,000 and 31.5% of those without private health insurance.

Michael Ngo

“We expected that a deductible would discourage some women from obtaining diagnostic imaging, but we were surprised that this effect was more prominent in racial minorities, low-income individuals, people with less education and Medicaid recipients,” Ngo said.

Moving forward, Ngo said prospective research should examine differences in compliance with diagnostic imaging, mortality rates and treatment delay between women with high deductibles and those without a deductible.

References:

• Ngo M, et al. Effect of a high deductible health plan on patients willingness to undergo indicated breast imaging. Presented at: Radiological Society of North America Annual Meeting; Nov. 27-Dec. 1, 2022; Chicago.
• Radiological Society of North America. High deductible leads women to skip testing after abnormal mammogram. press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?id=2394. Published Nov. 29, 2022. Accessed Dec. 2, 2022.