Abstract
BackgroundSeveral states in the US have passed laws mandating coverage of colorectal cancer (CRC) screening tests by health insurance plans. The impact of these state mandates on the use of colorectal cancer screening has not been evaluated among an age-eligible target population with access to care (i.e., health care insurance coverage).MethodsWe collected information on state mandates implemented by December 31, 2008 and used data on insured adults aged 50 and 64 years from the Behavioral Risk Factor Surveillance System between 2002 and 2008 to classify individual-level exposure to state mandates for at least 1 year. Multivariate logistic regression models (with state- and year- fixed effects, and patient demographic and socioeconomic characteristics) were used to estimate the effect of state mandates on recent endoscopy screening (either flexible sigmoidoscopy or colonoscopy during the past year).ResultsFrom 1999-2008, twenty-two states in the US, including the District of Columbia passed comprehensive laws requiring health insurance coverage of CRC screening including endoscopy tests. Residence in states with CRC screening coverage mandates in place for at least 1 year was associated with a 1.4 percentage point increase in the probability of utilization of recent endoscopy (i.e., 17.5% screening rates in those with mandates versus 16.1% in those without, Adjusted OR = 1.10, 95% CI: 1.02 - 1.20, p = 0.02).ConclusionsThe findings suggest a positive, albeit small, impact of state mandates on the use of recent CRC screening endoscopy among the target eligible population with health insurance. However, more research is needed to evaluate potential effects of mandates across health insurance types while including controls for other system-level factors (e.g. endoscopy and primary care capacity). National health insurance reform should strive towards a system that expands access to recommended CRC screening tests.
Highlights
Several states in the US have passed laws mandating coverage of colorectal cancer (CRC) screening tests by health insurance plans
For the more invasive and expensive CRC screening procedures, such as colonoscopy, a third of the plans covered colonoscopy and nine percent covered flexible sigmoidoscopy but only for patients deemed at high-risk
The purpose of this study was to assess the effect of state CRC screening coverage mandates on self-reported utilization of endoscopy among an insured population of US adults aged 50 to 64 years
Summary
Several states in the US have passed laws mandating coverage of colorectal cancer (CRC) screening tests by health insurance plans. The impact of these state mandates on the use of colorectal cancer screening has not been evaluated among an age-eligible target population with access to care (i.e., health care insurance coverage). For the more invasive and expensive CRC screening procedures, such as colonoscopy, a third of the plans covered colonoscopy and nine percent covered flexible sigmoidoscopy but only for patients deemed at high-risk This survey noted that for eighty-five percent of covering plans, the patient incurred cost-sharing, through co-insurance cost and/or deductibles, for endoscopy testing procedures (average range of charges $130 - $200 for flexible sigmoidoscopy and $400 - $ 650 for colonoscopy) [9]. Patient cost-sharing has been shown to reduce utilization of preventive services and may influence preferences of CRC screening tests [10,11,12]
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