Deductibles appear to discourage some patients from receiving recommended follow-up imaging, according to new survey data published Tuesday in Radiology.
The Affordable Care Act of 2010 has largely eliminated out-of-pocket payments for regular screening mammography. However, cost-sharing still persists for other follow-up exams, previous studies have shown. Obamacare also has propelled the popularity of high-deductible plans, aimed at incentivizing consumers to take charge of their care through lower premiums but higher payouts before insurance kicks in.
But a new analysis shows that such plans may be pushing patients away from necessary exams. About 21% of women surveyed said they would skip additional testing after a mammogram, if they were required to pay deductible, and 19.5% were unsure.
“Having a fifth of patients with abnormal screening mammography results consider forgoing or postponing indicated diagnostic imaging is concerning,” lead author, Michael Ngo, MD, a radiology resident at Boston Medical Center, and colleagues wrote April 4. “Such behaviors may lead to delays in breast cancer diagnosis and treatment, which have been associated with adverse outcomes, such as more advanced stage at diagnosis and lower survival rates.”
Researchers administered their paper-based survey to more than 6,100 patients presenting for breast imaging at their institution between 2021-2022. They received a total of 844 responses, after excluding a handful for incomplete answers. Latinas (33%), those with a high school education or less (31%), living in households earning less than $35,000 (27%), and on Medicaid or uninsured (31.5%) were likelier to decline additional imaging due to a deductible. More than 18% said they’d even skip the initial mammogram, if they knew that follow-up tests required such a payment, and 16% were undecided.
“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 healthcare disparities,” Ngo said in a statement from the Radiological Society of North America, announcing the results.
The findings echo another recent study published in JAMA Network Open, which pinpointed out-of-pocket costs as a persistent barrier to follow-up breast imaging.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.