Co-Pays Contribute to Drop in Preventive Care

Even small co-pays made some women opt out of screening mammographies, study finds

By Serena Gordon
HealthDay Reporter

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WEDNESDAY, Jan. 23 (HealthDay News) -- A co-pay as small as $10 can stand in the way of a woman getting a potentially lifesaving mammography, new research suggests.

When women in Medicare managed-care plans were asked to contribute a small co-pay, in some cases around $10 to $20, 8 percent of the women decided to forgo mammograms altogether, according to a study published in the Jan. 24 issue of the New England Journal of Medicine.

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"A small co-pay can lead to a sharp decrease in the breast cancer screening rate," said study author Dr. Amal Trivedi, an assistant professor of community health at the Warren Alpert School of Medicine at Brown University in Providence, R.I.

Trivedi said more and more, insurance plans are instituting cost-sharing in the form of co-pays, and the idea behind it is to get consumers to consider cost before getting health-care services. The hope is that people will reconsider potentially unnecessary procedures or medicines but not forgo essential health-care services. However, it doesn't always work out that way, as this study illustrates.

"This is an example where a co-pay had an adverse effect on health," Trivedi said. "For highly valuable services, such as mammography, insurers should eliminate co-pays. It could save lives. And, a small co-pay doesn't make a lot of economic sense if it deters women from getting timely screenings. The costs of untreated early disease are much higher."

Trivedi and his colleagues reviewed mammography data from 174 Medicare managed-care insurance programs. They reviewed data on 366,475 women between the ages of 65 and 69 from 2001 through 2004.

The researchers compared plans with cost-sharing to those that didn't. They also compared rates of mammography in plans with recently instituted co-pays to those that retained full coverage.

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