In Tougher Economy, Fewer Americans Get
FRIDAY, Feb. 24 (HealthDay News) -- Fewer people opted for
potentially lifesaving colonoscopies to screen for colon cancer
during the recent economic recession, largely because they couldn't
afford to pay high out-of-pocket costs often associated with this
test, new research finds.
During the recession of December 2007 to June 2009, about
500,000 fewer Americans who had health insurance underwent a
screening colonoscopy, compared to the two years before the
recession began. The study findings appear in the March issue of
Clinical Gastroenterology and Hepatology.
"In difficult economic times, people are more likely to forgo necessary medical services if there are high out-of-pocket costs," said study author Dr. Spencer Dorn, an assistant professor of medicine in the division of gastroenterology and hepatology at University of North Carolina at Chapel Hill. And "colonoscopy is never the most popular service to begin with."
During a colonoscopy, a doctor looks for abnormalities in the
interior lining of your large intestine -- the rectum and colon --
with a camera after a day-long bowel cleanse or prep. The U.S.
Preventive Services Task Force (USPSTF) recommends colorectal
screening for people aged 50 and 75.
Before the recession, the number of colonoscopies performed each
year increased steadily, largely because of general awareness of
the test's benefits and broader coverage by insurance companies,
The new study included data from 106 U.S. health plans on
colonoscopy rates before and during the recession among people aged
50 to 64. Those people with out-of-pocket costs of at least $300
were less likely to have a colonoscopy during the recession
compared to those with lower out-of-pocket costs, the study showed.
Out-of-pocket costs in the study referred to co-insurance
A similar trend -- higher co-pays and fewer cancer screenings --
seems to have occurred with mammograms, according to study
A recent study in the
New England Journal of Medicine showed colonoscopy can
prevent colorectal cancer and dramatically reduce deaths from the
disease. "Let's hope the economy gets better and we can try to get
rid of cost sharing for colonoscopy," Dorn said.
As part of health reform, federal changes are under way that do
away with co-pays for people covered by Medicare, Medicaid or new
insurers for any test that the USPSTF deems as grade A. This
Such cost-cutting measures are needed if Americans are to comply
with recommended screening guidelines, the study authors and other
Among them is Dr. Robynne Chutkan, an assistant professor of
medicine at Georgetown University Hospital in Washington, D.C.
"Screening colonoscopy saves lives and is an important part of the
preventive health care measures that we recommend for people age 50
and older," said Chutkan.
"One can only hope that at least some of the decrease in colonoscopies during the time period described represented people who were in financial straits at the time, but have now recovered and are able to refocus on their health," Chutkan said.
"We know that cost-sharing is a disincentive psychologically, even if the co-pay amount is small and 'affordable.' In principle, it is still a barrier for many people," Chutkan said.
Learn more about
colon cancer screening recommendations at the U.S.
Centers for Disease Control and Prevention.
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