Twenty percent of patients are likely to forgo additional testing after an abnormal finding on a screening mammogram if there is a deductible, according to new findings presented at the Radiological Society of North America (RSNA) 2022 Annual Meeting.
Background
As health-care costs and insurance premiums have increased in recent years—and with the advent of the Affordable Care Act—investigators have found that high-deductible health plans have become more popular. The health plans may lower overall health-care costs by making individuals more aware of their medical expenses, and lower monthly insurance premiums—making these plans an attractive option for young, healthy individuals who may typically need coverage only for preventative care or health emergencies.
But while high-deductible health plans offer some advantages, the high out-of-pocket deductible cost—in excess of $1,400 for individuals and $2,800 for families—may prevent people from seeking necessary care.
"The [Affordable Care Act] removed out-of-pocket costs for screening mammograms under most health plans to encourage [patients] to partake in this important preventative health-care measure," detailed lead study author, Michael Ngo, MD, a resident in the Department of Radiology at Boston Medical Center and the Boston University Chobanian & Avedisian School of Medicine. "However, the screening mammogram is only the first step in detecting breast cancer. If the radiologist detects an abnormal finding on the screening image, then additional images and a biopsy are needed to determine if the patient has cancer. The [Affordable Care Act] does not mandate insurance to cover the costs of these additional services."
Study Methods and Findings
Dr. Ngo and his colleagues set out to determine the relationship between high-deductible health plans and patients’ willingness to undergo indicated breast imaging.
"Prior studies have shown that out-of-pocket costs [may] deter patients from attending screening [mammograms],” stressed Dr. Ngo. “Other studies found that screening rates go down when there is an out-of-pocket cost for follow-up imaging after an abnormal finding on [a] screening [mammogram]. However, there is a lack of research into patient adherence to the recommended follow-up imaging when there is a deductible. Our research aims to address this paucity.”
For the study, the researchers surveyed 932 patients who underwent breast imaging at Boston Medical Center between September 2021 and February 2022. The survey was comprised of demographic questions on race, education level, annual household income, and insurance payor, as well as scenarios about the utilization of breast imaging.
When asked whether patients would skip indicated imaging if they knew they had to pay a deductible, 21.1% (151 of 714 respondents) said they would skip imaging, 59.4% (424 of 714) said they would not skip imaging, and 19.5% (139 of 714) were undecided.
The factors that led to the highest percentage of responses in favor of skipping additional imaging were those who were Hispanic (33.0%), were high school educated or less (31.0%), had a household income of less than $35,000 (27.0%), and were uninsured or receiving Medicaid (31.5%).
The survey also asked whether respondents would forgo the initial screening mammogram if they knew they would have to pay a deductible for follow-up tests—and found that 18.2% (129 of 707 respondents) said they would skip the screening mammogram, 65.8% (465 of 707) said they would not skip the mammogram, and 16.0% (113 of 707) were undecided.
"The results show that a deductible payment for follow-up breast imaging after an abnormal finding on [a] screening mammogram discourages 21% of [patients] from returning for additional evaluation and appears to lead 18% of [patients] to skip the initial free screening altogether," underscored Dr. Ngo.
Identifying socioeconomic barriers to health care is critical in addressing existing disparities and ensuring better outcomes for vulnerable patient populations. The researchers hope that these findings will be useful in efforts to remove financial barriers to care.
"Our study demonstrates that out-of-pocket payments will discourage people, especially those belonging [to] the most vulnerable populations, from completing the last steps in the breast cancer screening process," Dr. Ngo highlighted, emphasizing that "These results could be used to advocate for legislation that will cover these important follow-up tests and prevent further exacerbation of existing health inequities."
