Abstract
Both colonoscopy and fecal occult blood test (FOBT) are commonly used for colorectal cancer (CRC) screening, but colonoscopy costs much more than FOBT. Swiss insurance offers high or low deductibles and choice of basic or private insurance. We hypothesized that high deductibles and basic insurance discourage colonoscopy, but do not change FOBT rates. We determined the proportion of patients tested for CRC in Switzerland (colonoscopy within 10years, FOBT within 2years), and determined associations with health insurance type. We extracted data on 50-75-year-olds from the Swiss Health Interview Surveys of 2012 to determine colonoscopy and FOBT testing rates (n=7335). Multivariate logistic regression models estimated prevalence ratios (PRs) of CRC testing associated with health insurance type (deductible and private insurance), adjusted for socio-demographic factors (age, gender, education, income) and self-rated health. The weighted proportion of individuals tested for CRC within recommended intervals was 39.5%. Testing with colonoscopy was significantly associated with private insurance (PR 1.85, 95% CI: 1.46-2.35) and low deductible (PR 2.00, 95% CI: 1.56-2.57). Testing with FOBT was significantly associated with deductible (PR 1.71, 95%CI:1.09-2.68) but not with private insurance. About 60% of the Swiss population was not current with CRC testing. After adjusting for covariates, private insurance and low deductible was significantly associated with higher prevalence of CRC testing, indicating that waiving the deductible could increase CRC screening uptake and reduce health inequality.
Highlights
Colorectal cancer (CRC) is the third leading cause of cancer mortality in Switzerland, killing 1600 people annually (Arndt et al, 2016)
Colonoscopy and private insurance were significantly associated (PR 1.85 95% confidence interval (CI):1.46 to 2.35); faecal occult blood test (FOBT) testing and private insurance were not (PR 1.12, 95% CI: 0.84–1.49)
Colonoscopy, an expensive test, was significantly associated with private insurance and low deductible after multivariate adjustment for predictors of CRC testing (PR 1.88, 95% CI: 1.43–2.47)
Summary
Colorectal cancer (CRC) is the third leading cause of cancer mortality in Switzerland, killing 1600 people annually (Arndt et al, 2016). Most of these lives could be saved by CRC screening (Brenner et al, 2014; Meester et al, 2015). A later study based on the Swiss Health Interview Survey (SHIS) reported screening rates among 50–75-year-olds were 18.9% in 2007 and 22.2% in 2012 (Fedewa et al, 2015). In Switzerland, insurance only covered diagnostic tests for symptomatic patients before 2013, and not screening. In this period Switzerland lacked CRC screening programs that covered
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
