High-deductible health plans do not prevent routine cancer screenings

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Patients transitioning into a high-deductible health plan do not seem to forgo fully covered cancer screening. They do, however, seem to substitute use of a fully covered test for ones subject to the deductible (such as colonoscopy), according to a study published in the May 6 issue of Annals of Internal Medicine.

J. Frank Wharam, MD, and colleagues, from Harvard Medical School, Harvard Pilgrim Health Care, and Beth Israel Deaconess Medical Center—all located in Boston—sought to determine the effect of membership in a high-deductible health plan on cervical, breast and colorectal cancer screening.

The researchers examined 3,169 high-deductible health plan members and 27,022 HMO members in Massachusetts. The high-deductible health plan fully covered mammography, Papanicolaou tests and fecal occult blood testing (FOBT) but not colonoscopy, flexible sigmoidoscopy or double-contrast barium enema (DCBE).

Within these parameters, the investigators measured the change in the proportions of patients undergoing breast, cervical and colorectal cancer screening.

Wharam and colleagues found that cancer screening in the high-deductible health plan group was unchanged from baseline to follow-up (adjusted ratios of change: 1.04 for breast cancer, 1.04 for cervical cancer and 1.02 for colorectal cancer).

However, members may have substituted a fully covered screening test for tests subject to the deductible.

The high-deductible health plan members had colonoscopy, flexible sigmoidoscopy and DCBE less often (ratio of change, 0.73) and FOBT more often (ratio of change, 1.16) than HMO members, according to the researchers.

The authors wrote that their limitations include:

  • Population screening frequency was probably underestimated because the study could not assess screening before the baseline year.
  • The study may have included people ineligible for screening because of previous colectomy, mastectomy or hysterectomy.
  • A population with relatively high socioeconomic status, typical of employed, commercially insured populations.

However, Wharam and colleagues concluded that a “transition into a high-deductible health plan does not appear to be associated with avoidance of routine cancer screening.”