Document Detail

Modestly increased use of colonoscopy when copayments are waived.
MedLine Citation:
PMID:  22401903     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: Colorectal cancer (CRC) screening with colonoscopy often requires expensive copayments from patients. The 2010 Patient Protection and Affordable Care Act mandated elimination of copayments for CRC screening, including colonoscopy, but little is known about the effects of copayment elimination on use. The University of Texas employee, retiree, and dependent health plan instituted and promoted a waiver of copayments for screening colonoscopies in fiscal year (FY) 2009; we examined the effects of removing cost sharing on colonoscopy use.
METHODS: We conducted a retrospective cohort study of 59,855 beneficiaries of the University of Texas employee, retiree, and dependent health plan, associated with 16 University of Texas health and nonhealth campuses, ages 50-64 years at any point in FYs 2002-2009 (267,191 person-years of follow-up evaluation). The primary outcome was colonoscopy incidence among individuals with no prior colonoscopy. We compared the age- and sex-standardized incidence ratios for colonoscopy in FY 2009 (after the copayment waiver) with the expected incidence for FY 2009, based on secular trends from years before the waiver.
RESULTS: The annual incidence of colonoscopy increased to 9.5% after the copayment was waived, compared with an expected incidence of 8.0% (standardized incidence ratio, 1.18; 95% confidence interval, 1.14-1.23; P < .001). After adjusting for age, sex, and beneficiary status, the copayment waiver remained significantly associated with greater use of colonoscopy, with an adjusted hazard ratio of 1.19 (95% confidence interval, 1.12-1.26).
CONCLUSIONS: Waiving copayments for colonoscopy screening results in a statistically significant, but modest (1.5%), increase in use. Additional strategies beyond removing financial disincentives are needed to increase use of CRC screening.
Shabnam Khatami; Lei Xuan; Rolando Roman; Song Zhang; Charles McConnel; Ethan A Halm; Samir Gupta
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-03-05
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  10     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-16     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  761-766.e1     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Department of Internal Medicine, University of California San Diego, San Diego, California, USA.
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MeSH Terms
Cohort Studies
Colonoscopy / economics*,  trends*
Colorectal Neoplasms / diagnosis*
Fees and Charges*
Mass Screening / economics*,  trends*
Middle Aged
Patient Acceptance of Health Care / statistics & numerical data*
Retrospective Studies
Grant Support
1 KL2 RR024983-01/RR/NCRR NIH HHS; 1U54CA163308-01/CA/NCI NIH HHS; KL2 RR024983/RR/NCRR NIH HHS
Comment In:
Clin Gastroenterol Hepatol. 2012 Jul;10(7):767-8   [PMID:  22507879 ]

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