Researchers found that 20% of patients attending breast cancer screening appointments were likely to skip additional testing after abnormal findings on their mammograms if there was a deductible or copayment involved, according to a new study published by Ngo et al in Radiology.
Background
Health-care costs and insurance premiums have increased in recent years. With the advent of the Affordable Care Act, high-deductible health plans have grown in popularity—particularly among younger and healthier individuals.
Some believe that high-deductible health plans may lower overall health-care costs by making individuals more cognizant of their medical expenses. The higher deductibles may also lower monthly insurance premiums, making these plans an attractive option for individuals who may only need coverage for preventive care or health emergencies. However, while high-deductible health plans offer some advantages, the high out-of-pocket deductible costs—a minimum of $1,500 for individuals and $3,000 for families—may prevent patients from seeking necessary care.
“Currently, there is no out-of-pocket payment or copayment for screening mammograms since [they are] covered under the [Affordable Care Act],” explained lead study author Michael Ngo, MD, a resident in the Department of Radiology at the Boston University Chobanian & Avedisian School of Medicine. “However, any follow-up diagnostic imaging for an abnormal finding seen on a screening mammogram may require the patient to pay a copayment or deductible, depending on their health-care plan,” he added.
Methods and Findings of the Survey
In the new study, the researchers surveyed 932 patients presenting for breast cancer screenings between September 2021 and February 2022 in order to assess the impact these payments may have on patients’ likelihood of returning for important follow-up imaging. The survey comprised demographic questions on race, education level, annual household income, and insurance payor, as well as scenarios about the utilization of breast cancer screenings. The researchers noted there was a variable response rate on the survey questions.
Among 714 respondents, 21.2% (n = 151) stated that they would skip further indicated imaging if they knew they had to pay a deductible, 59.4% (n = 424) stated they would not skip further imaging, and 19.5% (n = 139) of them were undecided. “The patients who were more likely to say they would skip diagnostic imaging tended to be racial/ethnic minorities [and patients who had] a lower educational level, [had] a lower-income household, [and were] on Medicaid or [had] no insurance at all,” Dr. Ngo stressed.
Additionally, the researchers found that the groups with the highest percentage of responses indicating they would skip additional imaging were Hispanic individuals (33.0%), those who had a highest level of education of high school or less (31.0%), those with a household income of less than $35,000 (27.0%), and those who were on Medicaid or were uninsured (31.5%).
The survey also asked whether the respondents would forgo the initial screening mammograms if they knew they would have to pay a deductible for follow-up imaging. Among the 707 respondents, 18.3% (n = 129) reported that they would skip the screening mammograms, 65.8% (n = 465) would not skip the screening mammograms, and 16.0% (n = 113) were undecided.
Conclusions
“Prior research has shown that these groups tend to already have lower adherence to preventive services, including breast cancer screenings, and tend to have worse breast cancer outcomes. Based on these results, out-of-pocket payments may account for at least a part of the delay in seeking care. This, in turn, leads to delays in breast cancer diagnosis and treatment, increases overall breast cancer mortality, and exacerbates existing gaps in breast cancer care [for patients] who already have financial barriers in [cancer] care,” Dr. Ngo emphasized.
The researchers noted that identifying socioeconomic barriers to health care may be critical in addressing existing disparities and ensuring better outcomes for vulnerable patient populations. They hope their findings will inspire further efforts to remove financial barriers to cancer care.
“We hope these results can be used to advocate for legislation to eliminate out-of-pocket expenditure for screening diagnostic imaging follow-up to alleviate existing health-care disparities,” Dr. Ngo concluded.
Disclosure: For full disclosures of the study authors, visit pubs.rsna.org.
