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High deductible leads women to skip testing after abnormal mammogram

Press releases may be edited for formatting or style | November 29, 2022 Women's Health
CHICAGO – One in five women is likely to forgo additional testing after an abnormal finding on a screening mammogram if there is a deductible, according to a new study presented today at the annual meeting of the Radiological Society of North America (RSNA).

As health care costs and insurance premiums have increased in recent years and with the advent of the Affordable Care Act (ACA), high-deductible health plans (HDHPs) have grown in popularity, particularly among younger, healthy people.

It is believed that HDHPs lower overall health care costs by making individuals more cognizant of their medical expenses. The higher deductible also lowers monthly insurance premiums, making these plans an attractive option for healthy people who may typically need coverage only for preventative care or health emergencies.

But while HDHPs offer some advantages, the high out-of-pocket deductible cost—in excess of $1,400 for individuals and $2,800 for families—may prevent people from seeking necessary care.

"The ACA removed out-of-pocket costs for screening mammograms under most health plans to encourage women to partake in this important preventative health care measure," said the study's lead author, Michael Ngo, M.D., radiology resident at Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine. "However, the screening mammogram is only the first step in detecting breast cancer. If the radiologist detects an abnormal finding on the screening image, then additional images and a biopsy are needed to determine if the patient has cancer. The ACA does not mandate insurance to cover the costs of these additional services."

Dr. Ngo and colleagues set out to determine the relationship between HDHPs and patient's willingness to undergo indicated breast imaging.

"Prior studies have shown that out-of-pocket costs deter patients from attending screening mammography," Dr. Ngo said. "Other studies found that screening rates go down when there is an out-of-pocket cost for follow-up imaging after an abnormal finding on screening mammography. However, there is a lack of research into patient adherence to the recommended follow-up imaging when there is a deductible. Our research aims to address this paucity."

For the study, the researchers surveyed 932 patients presenting for breast imaging at Boston Medical Center between September 2021 and February 2022. The survey was comprised of demographic questions on race, education level, annual household income and insurance payor, as well as scenarios about utilization of breast imaging. There was a variable response rate on questions.

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