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Cost-Free Colonoscopies Don't Lead to Increase in Screenings

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Jennifer Morrow/Creative Commons
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Eliminating costs for some preventive screenings doesn't improve the likelihood of people whose insurance is covered through the Affordable Care Act getting the services, according to a recent study.

Researchers at University Hospitals Seidman Cancer Center in Cleveland found making colonoscopy available at no cost to eligible Medicare beneficiaries under the ACA did not increase the number of people who regularly undergo the procedure.

Colorectal cancer is the second-most common cause of cancer death in men and women combined in Kentucky, according to the Kentucky Cancer Consortium. Between 2007 and 2011, Kentucky continued to have the highest colorectal cancer incidence rate in the U.S. More than 2,600 Kentuckians are diagnosed with colorectal cancer each year.

In 2012, Kentucky ranked 28th in the United States for colon cancer screenings, with a screening rate of 65.9 percent.

Dr. Gregory Cooper, lead author of the study, said the removal of cost is a necessary but insufficient factor in whether people choose to be screened.

"You're certainly not hurting things by removing the costs, but for a procedure where there are so many other steps involved, cost is probably not the most important factor," he said.

The study examined preventative screenings for colorectal cancer and breast cancer between 2009 and 2012. The data show that before the ACA, only one-third of beneficiaries could obtain screenings with little or no out-of-pocket cost.

Under the ACA, all Medicare beneficiaries can receive certain screenings with no out-of-pocket cost.

The rates were for individuals 70 years of age and older. Annual colonoscopies are recommended for people ages 50 and older.

Doctors say the screenings are a key part of early detection for colorectal cancer.

Although there was no significant change in the number of colonoscopies, other types of screenings have increased since the health care law took effect. The rate of mammography increased 20 percent following the ACA's mandate for low or no cost screenings for Medicare recipients, the study said.

Cooper said cost has long been thought to be one of the main barriers in screenings. But his research shows there are other factors, such as access to care, time off from work, and overall apprehension about the procedure.

"Generally for colonoscopies, you have to have some sort of relationship with a primary care provider who would refer you to the procedure. So, if you don't have a primary care physician that you see, then that could be a limitation," he said.

A primary care physician can facilitate preventive screenings and answer a patient's questions, Cooper said. He also said having "health care navigators," individuals who help people looking for health care options, assist patients is also a big help.

He said hospitals that use navigators have higher rates of screenings.

"Using navigators to help guide somebody through the whole process to help them with the different barriers in terms of transportation and concerns that patients have," he said.