Copayments turn older women off to mammography

Copayments may make financial sense for insurers, but mammographers are appalled that some older women are avoiding routine screening because their Medicare managed-care plans force them to pony up for a portion of the imagingprocedure.

Dr. Amal Trivedi and colleagues at Brown University uncovered the pattern as they reviewed coverage for 174 Medicare managed-care plans and screening mammography utilization for those plans’ beneficiaries, more than 550,000 women aged 65 to 69. The study was published in the Jan. 24 New England Journal of Medicine (2008:358[4]:375-383).

They found that the number of Medicare managed-care plans that required a copayment of at least $12.50 (range: $12.50 to $35) or coinsurance of more than 10% for screening mammography increased from three plans in 2001 to 21 plans in 2004.

And the percentage of women who took advantage of Medicare’s biennial coverage of screening mammography decreased. Among plans that required cost sharing, the biennial breast cancer screening rates were 8.3 percentage points lower than for Medicare managed-care plans that provided full coverage (77.5% for full coverage versus 69.2% for cost-shared plans). Biennial screening mammography increased 3.4% in the four-year study period for women who participated in the plans that did not require copayments or coinsurance.

The findings were troubling for Dr. Carol H. Lee, chair of the American College of Radiology’s breast imaging commission.

“We are taking a segment of the population in whom the test works best and adding a disincentive to getting it. Given limited healthcare resources and limited dollars, perhaps this is not the best place to save money,” she said.