Recent economic challenges resulted in cutbacks in personal healthcare spending among continuously insured Americans, according to researchers at the University of North Carolina (UNC) at Chapel Hill School of Medicine. These insured patients underwent fewer screening colonoscopies, a cost-effective, recommended preventive service, during the recession.
The study appears in the March issue of the journal Clinical Gastroenterology and Hepatology.
UNC researchers estimated that during the recession period, December 2007 to June 2009 (defined by the National Bureau of Economic Research), colonoscopy screening for colorectal cancer was performed on approximately one-half million fewer Americans covered by commercial health insurance than expected, compared with the preceding 2 years.
The study consisted of 50- to 64-year-olds enrolled in 106 different US health plans that fed into the IMS LifeLink Health Plan Claims Database. This did not include Medicare or Medicaid patients.
Investigators also found a strong connection between direct out-of-pocket (OOP) costs for this elective procedure and whether patients were more likely to undergo the screening as recommended by their doctors.
“We found that patients facing high out-of-pocket costs were less likely to undergo colonoscopy at any time point, especially during the recession,” noted Spencer D. Dorn, MD, MPH, assistant professor of medicine in the division of gastroenterology and hepatology at UNC. “Before the recession, these individuals were less likely to get a screening colonoscopy, but the gap in use between those with high and low out-of-pocket costs was narrowing. But when the recession hit full force, the discrepancy in use widened again.” High OOP was defined as $300 or more; low OOP, $50 or less.
“These findings reflect the intimate link between socioeconomic factors and healthcare use,” the authors state. When otherwise healthy people who are covered by health insurance face economic insecurity, they “may be unable to afford screening colonoscopy, or may perceive it to be less important than competing demands for limited resources.”
The findings, say the authors, support the growing evidence that cost sharing is a deterrent for preventive health services. “Taken together, these studies argue for strategies to reduce patient cost sharing for colorectal cancer screening,” the report states.
Source: UNC Healthcare.