Insurance co-payments as low as $12 deter some older women from receiving mammograms, according to recent research by Amal Trivedi. an assistant professor of community health. The research was published last week in the New England Journal of Medicine and covered by ABC News and the Wall Street Journal.
Over a 10-year period, two to six of every 1,000 women screened could have their lives saved by mammography, according to estimates in an article published in the New England Journal of Medicine in 2003.
Trivedi, along with other researchers at Brown and one from Harvard, examined data compiled on 366,475 women aged 65 to 69 from Medicare managed care-plans from 2001 to 2004. They discovered that the women whose plans required a co-payment were 8.3 percent less likely to be screened than those whose insurance plans covered the full cost.
Trivedi said that "the magnitude of the effect" surprised him, since even modest co-payments were seriously deterring older women from receiving this necessary preventative test.
Trivedi researched mammography because it's a "very valuable preventative health service" and because extensive studies on the topic already exist. "There has been lots of research done on this in the past and it is generally accepted to be a very necessary thing for women," he said.
The researchers hope that the findings will disseminate to Medicare health plans, "so they are aware that modest co-payments can have a substantial negative effect on breast cancer spending rates," Trivedi said.
The screening rate among even the women with full coverage plans was still only 77.5 percent, indicating other barriers exist besides payment. Lack of a local mammography facility, education on mammogram's benefits and a doctor's recommendation that a given woman have the test are also obstacles, according to Trivedi. But co-payment remains "a substantial deterrent and one that can be eliminated," he stressed.
The research also suggested that elderly women are particularly affected by co-payments. "They have a fixed income so they don't have as much money to pay out of pocket," Trivedi explained.
The study concluded that, "For effective preventive services such as mammography, exempting elderly adults from cost sharing may be warranted." Trivedi said he hopes to see legislation passed to make mammograms free to elderly women. "We think that would be a valuable policy implication of our studies and that eliminating co-payments for mammograms could save lives," he said.
In light of these findings, Trivedi intends to study other tests, such as those for colon cancer screening, people with diabetes and people who have a history of heart disease.
