Nav: Home

Mammogram rates increase after ACA eliminates co-payments

January 17, 2018

PROVIDENCE, R.I. [Brown University] -- After the Affordable Care Act (ACA) eliminated cost sharing for screening mammograms, their rate of use rose six percentage points among older woman for whom such screenings were recommended, a new study in the New England Journal of Medicine finds.

"Out-of-pocket costs can be a potent barrier to receiving recommended preventive care," said Dr. Amal N. Trivedi, lead author. "The study showed that making mammograms free led to an increase in their use. That is good for public health."

Trivedi is an associate professor of health services, policy and practice, and an associate professor of medicine at Brown University.

Research shows that requiring deductibles, copayments or other out-of-pocket expenses reduces the use of effective, but often underused, preventive health care services, such as screening mammograms, Trivedi said. One strategy of the ACA is to selectively eliminate copayments for higher-value care, such as screening mammography, to increase the use of these services and improve population health, he said.

The U.S. Preventive Services Task Force recommends that women age 50 to 74 years undergo screening mammography every two years (biennially) to check for the presence of breast cancer.

In the study, Trivedi and colleagues looked at biennial screening mammography among 15,085 women age 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for the service, compared with 52,035 women in 48 matching Medicare Advantage plans that had and maintained full insurance coverage for mammography.

By examining 24 unique plans, and 72 in total, this is among the largest studies to date of the effects of an ACA cost-sharing provision for a preventive health service.

The researchers found that among Medicare Advantage plans that eliminated cost sharing, rates of screening mammography increased about six percentage points, compared with plans that maintained full coverage for the service. These gains were concentrated among women with more education, but lower for those less educated and unchanged for Hispanic women.

Other studies have shown that patients, particularly those with incomes near the poverty level, are often unaware that the ACA eliminated cost sharing for preventive care. In addition, "Latino patients have been found to have less awareness of the ACA than the general population," the authors wrote.

"We have work to do when it comes to women with less education and Hispanic women," Trivedi said. "They need to be better aware of the cost-sharing provisions of the ACA."

Breast cancer is the second leading cause of cancer-related death among women. The disease most commonly occurs among older women. Research shows that age-appropriate screening mammography reduces breast-cancer-related mortality and is cost effective, Trivedi said.

Meanwhile, the ACA faces continued opposition among some lawmakers. "If the cost-sharing provisions of the ACA are rescinded, our results raise concern that fewer older women will receive recommended breast-cancer screening," wrote the authors.

Of the 44 preventive services recommended for adults, 26 apply specifically to women, and none to men. Those services range from contraceptive care to pre-natal visits to screening mammograms.

Women are disproportionately affected by out-of-pocket payments for preventive services, Trivedi said. A requirement for even modest copayments for preventive services, such as mammograms or Pap smears, reduces the number of women who receive this care, he said.

In previous research, Trivedi and colleagues found that copayments of approximately $20 were associated with up to an 11-percentage-point drop in rates of breast-cancer screening.

"Our latest findings extend those of previous studies showing that, among older women, receipt of screening mammography is sensitive to out-of-pocket costs and the presence of supplemental coverage," Trivedi said.
-end-
Grants from the National Institute on Aging of the National Institutes of Health supported the study. Other authors include medical student Bryan Leyva, biostatistician Yoojin Lee, and assistant professors Orestis Panagiotou and Issa Dahabreh, all from Brown University.

Brown University

Related Mammography Articles:

Mammography screening: Only 1 in 3 women is well-informed
Only one in three women participating in Germany's mammography screening program is well-informed about it: the higher the level of education, the greater the chance of women making an informed decision.
Menopausal status a better indicator than age for mammography frequency
In a study conducted to inform American Cancer Society breast cancer screening guidelines, UC Davis researcher Diana L.
Computer-aided mammography detection not associated with improved accuracy
Computer-aided detection in screening mammography was not associated with improved diagnostic accuracy in a study that analyzed results from a large Breast Cancer Surveillance Consortium database of digital screening mammograms, according to an article published online by JAMA Internal Medicine.
Mammography benefits overestimated
An in-depth review of randomized trials on screening for breast, colorectal, cervical, prostate and lung cancers, published in the Journal of the Royal Society of Medicine, shows that the benefits of mammographic screening are likely to have been overestimated.
3-D mammography improves cancer detection in dense breasts
A major new study has found that digital breast tomosynthesis, also known as 3-D mammography, has the potential to significantly increase the cancer detection rate in mammography screening of women with dense breasts.
New device may ease mammography discomfort
Researchers have developed a new device that may result in more comfortable mammography for women.
Screening with tomosynthesis and mammography is cost-effective
Adding tomosynthesis to biennial digital mammography screening for women with dense breasts is likely to improve breast cancer detection at a reasonable cost relative to biennial mammography screening alone, according to a new study.
Mammography benefits women over 75
Mammography-detected breast cancer is associated with a shift to earlier stage diagnosis in older women, subsequently reducing the rate of more advanced, difficult-to-treat cases, according to a new study.
The mammography dilemma
A comprehensive review of 50 years' worth of international studies assessing the benefits and harms of mammography screening suggests that the benefits of the screening are often overestimated, while harms are underestimated.
Digital mammography reduces recall and biopsy rates
Population-based screening with full-field digital mammography is associated with lower recall and biopsy rates than screen film mammography, suggesting that full-field digital mammography may reduce the number of diagnostic workups and biopsies that do not lead to diagnosis of breast cancer, according to a new study.

Related Mammography Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Changing The World
What does it take to change the world for the better? This hour, TED speakers explore ideas on activism—what motivates it, why it matters, and how each of us can make a difference. Guests include civil rights activist Ruby Sales, labor leader and civil rights activist Dolores Huerta, author Jeremy Heimans, "craftivist" Sarah Corbett, and designer and futurist Angela Oguntala.
Now Playing: Science for the People

#521 The Curious Life of Krill
Krill may be one of the most abundant forms of life on our planet... but it turns out we don't know that much about them. For a create that underpins a massive ocean ecosystem and lives in our oceans in massive numbers, they're surprisingly difficult to study. We sit down and shine some light on these underappreciated crustaceans with Stephen Nicol, Adjunct Professor at the University of Tasmania, Scientific Advisor to the Association of Responsible Krill Harvesting Companies, and author of the book "The Curious Life of Krill: A Conservation Story from the Bottom of the World".