• Posted April 5, 2023

High Co-Pays, Deductibles Keep Some Women From Mammogram Follow-Up

A new study shows that money, or lack of it, can stand in the way of follow-up testing after an abnormal mammogram result.

Just over one-fifth of U.S. women surveyed by researchers said they would skip additional testing if they had to pay a deductible or co-pay.

Of 714 women who responded when asked if they'd have follow-up imaging if they had to pay for all or part of it, 21% said they would skip imaging, 59% said they would not skip imaging and 19.5% were undecided.

"Currently, there is no out-of-pocket payment or co-payment for screening mammography since it's covered under the ACA [Affordable Care Act],"said study lead author Dr. Michael Ngo, a radiology resident at Boston Medical Center. "However, any follow-up diagnostic imaging for an abnormal finding seen on screening mammography may require the patient to pay a co-payment or deductible, depending on their health care plan."

High-deductible health plans (HDHPs) have become popular since the Affordable Care Act (ACA) began, and so health care costs and insurance premiums have increased in recent years.

HDHPs are thought to lower overall health care costs by making individuals more aware of their medical expenses. The higher deductible also lowers monthly insurance premiums.

However, HDHPs also have a high out-of-pocket deductible cost -- a minimum of $1,500 for individuals and $3,000 for families.

The Boston survey also included demographic questions on race, education level, annual household income and insurance payor.

"The patients who were more likely to say they would skip diagnostic imaging tended to be racial/ethnic minorities, have a lower educational level, have a lower-income household, are on Medicaid or have no insurance at all,"Ngo said in a news release from the Radiological Society of North America.

About 33% of Hispanic women said they would skip additional imaging. So did 31% of those who had a high school education or less, 27% of those with a household income of less than $35,000, and 31.5% who were on Medicaid or uninsured.

"Prior research has shown that these groups tend to already have lower adherence to preventative services, including breast cancer screening, and tend to have worse breast cancer outcomes,"Ngo said. "Based on these results, these out-of-pocket payments may account for at least a part of the delay in seeking care. This, in turn, leads to delays in breast cancer diagnosis and treatment, increases overall breast cancer mortality and exacerbates existing gaps in breast cancer care in women who already have financial barriers in care."

About 18% of women said they would skip even the initial mammogram if they knew they would have to pay for a follow-up screening. Nearly 66% said they would not skip this initial screening and 16% were undecided, the investigators found.

The findings were published April 4 in the journal Radiology.

The researchers said identifying socioeconomic barriers to health care is critical to addressing disparities and providing better outcomes for vulnerable patients.

"We hope these results can be used to advocate for legislation to eliminate out-of-pocket expenditure for screening diagnostic imaging follow-up, to alleviate the existing health care disparities,"Ngo said.

Another study in a much larger group, published online recently in JAMA Network Open, also found that women with high deductibles were less likely to access follow-up screening.

More information

The U.S. Centers for Disease Control and Prevention has more on mammograms.

SOURCE: Radiological Society of North America, news release, April 4, 2023