title: Cancer screening before and after switching to a high-deductible health plan.
abstract: BACKGROUND
  Health plans with high deductibles could lead patients to avoid preventive care, such as cancer screening.
  
  
  OBJECTIVE
  To determine the effect of membership in a high-deductible health plan on cervical, breast, and colorectal cancer screening.
  
  
  METHODS
  Before-after comparison between groups.
  
  
  METHODS
  A high-deductible health plan and an HMO in Massachusetts. The high-deductible health plan fully covered mammography, Papanicolaou tests, and fecal occult blood testing (FOBT) but not colonoscopy, flexible sigmoidoscopy, or double-contrast barium enema (DCBE).
  
  
  METHODS
  3169 high-deductible health plan members and 27,022 HMO members (who served as controls).
  
  
  METHODS
  Change in the proportions of patients undergoing breast, cervical, and colorectal cancer screening.
  
  
  RESULTS
  Cancer screening in the high-deductible health plan group was unchanged from baseline to follow-up (adjusted ratios of change, 1.04 [95% CI, 0.91 to 1.19] for breast cancer, 1.04 [CI, 0.92 to 1.17] for cervical cancer, and 1.02 [CI, 0.89 to 1.16] for colorectal cancer). High-deductible health plan members had colonoscopy, flexible sigmoidoscopy, and DCBE less often (ratio of change, 0.73 [CI, 0.56 to 0.95]) and FOBT more often (ratio of change, 1.16 [CI, 1.01 to 1.33]) than HMO members.
  
  
  CONCLUSIONS
  Population screening frequency was probably underestimated because the study could not assess screening before the baseline year. The study may have included people ineligible for screening because of previous colectomy, mastectomy, or hysterectomy. The findings are limited to a population with relatively high socioeconomic status, which is typical of employed, commercially insured populations.
  
  
  CONCLUSIONS
  Members of a high-deductible health plan did not seem to change their use of breast, cervical, and colorectal cancer screening when tests were fully covered. However, members may have substituted a fully covered screening test (FOBT) for tests subject to the deductible (colonoscopy, flexible sigmoidoscopy, and DCBE).
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Health Care, and Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. jwharam@partners.org
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
authors.forename: Alison A
authors.initials: AA
authors.lastname: Galbraith
authors.forename: Ken P
authors.initials: KP
authors.lastname: Kleinman
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003669:Deductibles and Coinsurance; D004733:Enema / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D065006:Papanicolaou Test; D012812:Sigmoidoscopy / Q000191:economics / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data