Even small copay deters mammogram use, study says

By Gene Emery

PROVIDENCE, Rhode Island (Reuters) - Requiring even a small co-payment dramatically reduces the likelihood that women will get regular mammograms to detect breast cancer, researchers reported on Wednesday.

Screening rates from 2001 through 2004 were nearly 11 percent lower for women who had to contribute a co-pay as low as $12, compared to women whose mammograms were free, researchers from Brown and Harvard universities found.

"I think it's a surprising result," said Dr. Amal Trivedi of Brown, who led the study. "Most people would consider $12 to be a rather modest sum. But when it came to this population, co-payments as low as $12 led to a very sharp decrease in the breast cancer screening rate."

Studies have suggested that mammograms may save lives by detecting breast cancers at an earlier, and more curable, stage. "This is a case where co-payments adversely affected health," Trivedi said in a telephone interview.

Breast cancer is more difficult - and more expensive - to treat at its later stages.

"It would make clinical sense, and probably economic sense, for a health plan to eliminate a co-payment for a mammogram," Trivedi said.

Breast cancer was diagnosed in 178,000 U.S. women in 2007, and killed more than 40,000, according to the American Cancer Society, which recommends regular mammograms for women over 40.

The researchers surveyed more than 366,000 women aged 65 to 69. They found that mammography rates were about 4 percent lower for women living in areas where the people were poor or poorly educated, if they were required to pay part of the cost. Most plans require a $20 co-payment.

In 2001 only one woman in 200 was required to make a co-pay for a mammogram. By 2004 the ratio was 1 in 9.

The researchers reported in the New England Journal of Medicine that when patients were suddenly required to foot part of the bill, screening rates declined by 5.5 percentage points even as the rates among women in plans that continued to pay the full cost increased by 3.4 percentage points.

Dr. Peter Bach of the Memorial Sloan-Kettering Cancer Center in New York said the study "tests a fundamental presumption of the high-deductible movement - that a knowledgeable consumer will make wise decisions when purchasing health care."

But even though nearly all women know the value of mammograms, many did not get them when they had to pay.

"The findings suggest that the introduction of a small out-of-pocket expense led 8 percent of consumers to opt out of mammography - a decision that, on average, was not in the best interest of their health," Bach wrote in a commentary.

Data from women in 174 Medicare managed-care plans in 38 states was used for the study. These plans represent one in six Medicare recipients. "It's reasonable that our findings would extend to people beyond this selected group," Trivedi said.