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Effect of Cost Sharing on Screening Mammography in Medicare Health Plans

Effect of Cost Sharing on Screening Mammography in Medicare Health Plans BackgroundPolicies that increase patients' share of health care expenses decrease the use of discretionary health services but also may reduce the use of important preventive care such as mammography.MethodsWe reviewed coverage for mammography within 174 Medicare managed-care plans from 2001 through 2004. Among 550,082 individual-level observations for 366,475 women between the ages of 65 and 69 years, we compared rates of biennial breast-cancer screening in plans requiring cost sharing for mammography with screening rates in plans with full coverage. We also performed a longitudinal analysis of screening rates in plans that changed from full coverage to cost sharing for mammography as compared with rates in matched control plans that did not institute cost sharing.ResultsThe number of plans with cost sharing for mammography, which we defined as requiring a copayment of more than $10 or coinsurance of more than 10% for screening mammography, increased from 3 in 2001 (representing 0.5% of women) to 21 in 2004 (11.4% of women). Biennial screening rates were 8.3 percentage points lower in cost-sharing plans than in plans with full coverage, a difference that persisted in adjusted analyses (P<0.001). The effect of cost sharing was magnified among women residing in areas of lower income or educational levels (P<0.001 for each interaction). Screening rates decreased by 5.5 percentage points in plans that instituted cost sharing and increased by 3.4 percentage points in matched control plans that retained full coverage (P<0.001 for the adjusted analysis).ConclusionsRelatively small copayments were associated with significantly lower mammography rates among women who should undergo screening mammography according to accepted clinical guidelines. For effective preventive services such as mammography, exempting elderly adults from cost sharing may be warranted. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The New England Journal of Medicine The New England Journal of Medicine

Effect of Cost Sharing on Screening Mammography in Medicare Health Plans

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References (40)

Publisher
The New England Journal of Medicine
Copyright
Copyright © 2008 Massachusetts Medical Society. All rights reserved.
ISSN
0028-4793
eISSN
1533-4406
DOI
10.1056/NEJMsa070929
pmid
18216358
Publisher site
See Article on Publisher Site

Abstract

BackgroundPolicies that increase patients' share of health care expenses decrease the use of discretionary health services but also may reduce the use of important preventive care such as mammography.MethodsWe reviewed coverage for mammography within 174 Medicare managed-care plans from 2001 through 2004. Among 550,082 individual-level observations for 366,475 women between the ages of 65 and 69 years, we compared rates of biennial breast-cancer screening in plans requiring cost sharing for mammography with screening rates in plans with full coverage. We also performed a longitudinal analysis of screening rates in plans that changed from full coverage to cost sharing for mammography as compared with rates in matched control plans that did not institute cost sharing.ResultsThe number of plans with cost sharing for mammography, which we defined as requiring a copayment of more than $10 or coinsurance of more than 10% for screening mammography, increased from 3 in 2001 (representing 0.5% of women) to 21 in 2004 (11.4% of women). Biennial screening rates were 8.3 percentage points lower in cost-sharing plans than in plans with full coverage, a difference that persisted in adjusted analyses (P<0.001). The effect of cost sharing was magnified among women residing in areas of lower income or educational levels (P<0.001 for each interaction). Screening rates decreased by 5.5 percentage points in plans that instituted cost sharing and increased by 3.4 percentage points in matched control plans that retained full coverage (P<0.001 for the adjusted analysis).ConclusionsRelatively small copayments were associated with significantly lower mammography rates among women who should undergo screening mammography according to accepted clinical guidelines. For effective preventive services such as mammography, exempting elderly adults from cost sharing may be warranted.

Journal

The New England Journal of MedicineThe New England Journal of Medicine

Published: Jan 24, 2008

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