nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Saturday, October 16, 2010

STUDY: Eliminating Insurance Deductibles Results In More Prevention Screening...By Just A Smidgeon

If prevention was free, would more people obtain age-appropriate screening tests?  Not so much, apparently.

This is just a reminder that health care cost is not the only factor determining health-seeking behavior.

A study (reviewed in the WSJ Health Blog, Oct 15) looked at what happens when you remove the health plan deductible payment.  I'm sure all of you have pesonal experience of this:  every year--in many plans--you must spend a certain amount before your insurance kicks in.  Some people, most government plans in particular, don't have this; theircoverage begins with the first dollar.

Once you meet your deductible, insurance starts to pay...anywhere from 100% (so-called Cadillac plans) down to 70% or less.  And certain types of treatment may be covered for even less.  Braces for your kids, for instance.  You pay the rest (the co-pay).

In any case, the researchers wanted to see whether removing the deductible caused a rise in how many people would get preventive health exams and testing performed.  Note that they didn't remove the co-pay--that remained the same as for any visit for health care.

The results?  Less than one percent increase in prevention seeking.
They analyzed data covering three different groups: people in high- and low-deductible plans, before and after the preventive care deductible was eliminated; and a control group from another employer where the deductible for preventive care didn’t change. ...Scrapping the deductible “modestly” improved screening rates for blood-cholesterol tests, Pap smears, mammograms and fecal-occult blood tests, the researchers conclude. After adjusting for demographics and the overall trend of the test’s use, “there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens.”  (WSJ Health Blog)
[Note:  I couldn't find the original study.  So, a caveat...]

Interesting, but maybe predictable, was the finding that people with "high-deductible" plans were least influenced.  The authors speculate that these are the people who are the least "risk-averse."  That is, they buy coverage just for big costs or catastrophic needs, and therefore, don't see their own health risk as high enough priority to warrant investment in a costlier plan.  Further, because they seek risk this way, they will be less likely to respond to a prevention incentive, even if the cost is reduced. [Alternatively, people with catastrophic coverage may choose these plans because they can't afford more, even if the deductible is eliminated.  There's not data to support either explanation.]

Repeat note:  I've written about this before.  Prevention is good medicine, but it doesn't often lower lifetime healthcare costs.  See my post, or just think about it:  which generates more cost?  someone who dies young, or someone who lives much longer?  Claims (notably by the President) that prevention lowers cost are misleading.

The point is, people are complex and are likewise complex in how they are motivated.  Just reducing or eliminating cost isn't even close to the whole answer  [Also, see this for how income and insurance don't explain racial disparities in breast cancer care.].

In a related vein, take a look at the article written by a nurse practitioner explaining why she doesn't get screening mammography despite a family history of breast cancer.  It's a reasoned and understandable decision, if not the one I would recommend to patients.

I'm male, so I can't relate completely.  However, similar reasoning applied to prostate cancer (the level of risk is about the same, statistically.  And, my Dad had it), leads me to the decision to get screened.  My sense of well-being is disturbed by the existence of unexplored risk, and I will act aggressively to reduce it...despite the fact that there's a similar level of complications from un-needed prostate treatment as there are for un-needed breast mass treatment.

I have no problem with people making informed choices, even if I don't agree with them.  We should be in charge of our bodies, and nobody else.

Doc D
PS:  "Smidgeon"  is a highly technical medical term that indicates a quantity somewhere between "it's there when look close" and a "pinch."

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