Do High-Deductible Health Plans Discourage Patients From Additional Testing After an Abnormal Mammogram?

By: Victoria Kuhr, BA
Posted: Monday, December 12, 2022

Michael Ngo, MD, of Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, and colleagues observed that a deductible payment for follow-up breast imaging from an abnormal screening may have discouraged 21% of women from returning for a diagnostic workup. Additionally, a deductible payment appeared to lead 18% of women to skip screening altogether. These findings were presented at the 2022 Radiological Society of North America (RSNA) Annual Meeting.

“Our study demonstrates that out-of-pocket payments will discourage people, especially those belonging in the most vulnerable populations, from completing the last steps in the breast cancer screening process,” said Dr. Ngo in an RSNA press release. “These results could be used to advocate for legislation that will cover these important follow-up tests and prevent further exacerbation of existing health inequities.”

The study analyzed completed paper surveys given to patients presenting for breast imaging at a safety net academic medical center from September 2021 to February 2022. The survey consisted of demographic questions on race, education level, annual household income, and insurance payor, as well as scenarios about the use of breast imaging.

A total of 932 surveys were collected, with variable question completion rates. When asked whether they would skip indicated imaging if they knew they had to pay a deductible, 151 of 714 respondents (21.2%) agreed they would skip imaging, 424 (59.4%) disagreed, and 139 (19.5%) were undecided. Some of the patients from the group with the highest percentage of responses reporting they would skip additional imaging were Hispanic (33.0%), high school–educated or less (31%), had a household income of less than $35,000 (27%), and were Medicaid or uninsured (31.5%).

Additionally, the survey asked whether respondents would skip additional mammography screenings if they knew they had to pay a deductible for follow-up tests (imaging or biopsy). Of 707 respondents, 129 (18.3%) agreed to skip imaging, 465 (65.8%) would not skip mammography, and 113 (16.0%) were undecided.

Disclosure: Disclosure information for the study authors was not provided.

2022 RSNA Annual Meeting