Copayments Reduce Likelihood Women Will Receive Regular Mammograms

Armen Hareyan's picture

A copayment of $12.50 to$35 reduces by 8.3 percentage points the likelihood that women will receive regularmammograms to detect breast cancer, according to a study published on Thursdayin the New England Journal of Medicine, the Wall Street Journal reports (Armstrong, WallStreet Journal, 1/24).


For the study, Amal Trivedi of Brown University and colleagues examined data frommore than 366,000 women ages 65 to 69 who were enrolled in 174 Medicare managedcare plans in 38 states (Emery, Reuters, 1/23). During the study, thenumber of plans requiring a copay for a mammogram increased from three in 2001to 21 in 2004. Most copays were $20, but the amounts ranged from $12.50 to $35(Wall Street Journal, 1/24). The study found that mammogram ratesincreased by 3.4 percentage points among women in plans that paid the fullamount, while the rates declined by 5.5 percentage points among women who had acopay.

Peter Bach of the Memorial Sloan-Kettering CancerCenter said thestudy "tests a fundamental presumption of the high-deductible movement --that a knowledgeable consumer will make wise decisions when purchasing healthcare." He added in an NEJM editorial that the "findingssuggest that the introduction of a small out-of-pocket expense led 8% ofconsumers to opt out of mammography -- a decision that, on average, was not inthe best interest of their health."

Trivedi said, "I think it's a surprising result," adding, "Mostpeople would consider $12 to be a rather modest sum. But when it came to thispopulation, copays as low as $12 led to a very sharp decrease in the breastcancer screening rate." In addition, he said, "It would make clinicalsense, and probably economic sense, for a health plan to eliminate a copay fora mammogram" (Reuters, 1/23). The researchers alsorecommended that Medicare eliminate copays for mammograms (AP/,1/23).

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