Breast Cancer Screening Co-Pay Could Hurt Insurers’ Bottom Line

A new study in The New England Journal of Medicine found that a modest insurance co-pay was enough to deter many older women from getting potentially life-saving mammograms.

The study examined 366,475 women between the ages of 65 to 69 enrolled at 174 Medicare managed-care plans. Screening rates were 8.3% lower for women whose plans required a co-payment (versus women whose plans covered the entire cost). Co-pays averaged $20, but ranged from $12.50 to $35. During the four-year study, the number of plans requiring co-pays rose 10%, from three plans in 2001 to 21 in 2004.

Mammography has been shown to reduce the rate of mortality by as much as 20 – 40%. Because it is cheaper to treat breast cancer when caught early, it may be cost-effective for insurers to exempt elderly patients from mammogram co-pays. The American Cancer Society estimates that there were 40,060 breast cancer fatalities in 2007. Approximately 80% of breast cancers occur in women over the age of 50; in women over 65 the cancer kills one out of two.

The study supports the idea of value-based insurance, in which insurers lower co-pays and other costs to patients as a way of increasing compliance and standards of care. While such strategies may increase short term expenditures, savings can be accrued over the long term by improving the patient’s health.

With technologies on the horizon that could detect cancer in its earliest stages, insurers may begin to selectively target treatments that are best for the patient, and best for their bottom line.

[Breast Cancer Mortality Rates: Surveillance, Epidemiology, and End Results (SEER) Program, April 2004]

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