Two-year Trends in Cancer Screening Among Low Socioeconomic Status Women in an HMO-based High-deductible Health Plan

Abstract

BACKGROUND: Cancer screening is often fully covered under high-deductible health plans (HDHP), but low socioeconomic status (SES) women still might forego testing. OBJECTIVE: To determine the impact of switching to a HDHP on breast and cervical cancer screening among women of low SES. DESIGN: Pre-post with comparison group. PARTICIPANTS: Four thousand one hundred and eighty-eight health plan members enrolled for one year before and up to two years after an employer-mandated switch from a traditional HMO to an HMO-based HDHP, compared with 9418 propensity score matched controls who remained in HMOs by employer choice. Both groups had low outpatient copayments. High-deductible members had full coverage of mammography and Pap smears, but $500 to $2000 individual deductibles for most other services. HMO members had full coverage of cancer screening and low copayments for other services without any deductible. We stratified analyses by SES.

The Impact of High-deductible Health Plans on Men and Women

“…8,21,23,24 The propensity score models used logistic regression to predict the likelihood of switching to an HDHP versus remaining in a traditional HMO based on age, sex, Adjusted Clinical Groups score, neighborhood education and poverty levels (from census-based geocoded data, below), family versus individual plan, index date, employer size, and baseline outpatient, ED, and hospital copayments. We also conducted sensitivity analyses using 2:1 and 1:1 matches.…”

Availability of Consumer Prices From US Hospitals for a Common Surgical Procedure

“…20 The health insurance industry has taken steps to encourage patients to demand pricing transparency through innovative health insurance benefits designs. Such innovations include high-deductible health plans and reference pricing in which insurance provides a fixeddollar contribution toward a given procedure with the patient responsible for any additional cost 21,22 ; both designs are meant to provide incentive for patients to think about cost in addition to other factors. Our results suggest that such efforts at pricing transparency have not been well integrated into the operations at many hospitals.…”

The long term effects of “Consumer-Directed” health plans on preventive care use

“…A number of prior papers has found no difference among CDHP enrollees in cancer screening rates (Rowe et al 2008; Wharam et al 2008; Wharam et al 2012). Fronstin et al (2013) found a decrease in the first year after enrollment, but no effect after year two.…”

“…One is that most of these studies use data from a single treatment employer (Fronstin et al 2013; Brot-Goldberg et al 2017) or a single insurance carrier (Wharam et al 2008; Wharam et al 2011; Wharam et al 2012; Fronstin et al 2013; Brot-Goldeberg et al 2017; Rowe et al 2008; Charlton et al 2011). Because of the small number of treated units, idiosyncratic changes may drive the results.…”

“…All studies used a difference-in-difference specification but the plausible exogeneity of treatment differed across studies. About half used firms that fully replaced an existing traditional plan with a CDHP (Wharam et al 2008; Wharam et al 2011; Wharam et al 2012; Fronstin et al 2013; Brot-Goldberg et al 2017). While using a full replacement firm eliminates bias from individual-level section into a CDHP, it does not account for firm level selection.…”