TY - JOUR
T1 - Impact of the 2008-2009 Economic Recession on Screening Colonoscopy Utilization Among the Insured
AU - Dorn, Spencer D.
AU - Wei, David
AU - Farley, Joel F.
AU - Shah, Nilay D.
AU - Shaheen, Nicholas J.
AU - Sandler, Robert S.
AU - Kappelman, Michael D.
N1 - Funding Information:
Funding This research was supported, in part, by grants from the National Institutes of Health ( K12HS019468 [to S.D.D.] and P30 DK034987 [to R.S.S.]) and a career development award from the Crohn's and Colitis Foundation of America (to M.D.K.).
PY - 2012/3
Y1 - 2012/3
N2 - Background & Aims: Economic factors might affect the use of recommended preventative services. We sought to determine whether the recent severe economic recession was associated with diminished screening colonoscopy rates among an insured population and to assess the relationship between out-of-pocket (OOP) costs and screening colonoscopy use. Methods: Administrative data from 106 health plans (IMS LifeLink Health Plan Claims Database) were analyzed to determine monthly rates of screening colonoscopies performed on beneficiaries ages 50 to 64 years between January 2005 and November 2007 (prerecession), as well as from December 2007 through June 2009 (recession). Segmented regression models were used to evaluate changes in screening colonoscopy rates, as well as the relationship between screening and OOP costs before and during the recession. Results: Compared with prerecession trends, during the recession screening colonoscopy rates decreased by 68.9 colonoscopies/1 million individuals per month (95% confidence interval, -84.6 to -53.1; P < .001). Application of study estimates to the entire US population indicated that during the recession, commercially insured patients aged 50 to 64 years underwent approximately 500,000 fewer screening colonoscopies. Compared with those with low OOP costs, those with high OOP procedure costs had lower rates of screening before and during the recession, and had a greater reduction in screening rates during the recession (P = .035). Conclusions: During the recession of December 2007 to June 2009, insured individuals reduced their use of screening colonoscopy compared with the 2 years before the recession began. OOP costs were related inversely to screening use, especially during the recession. Policies to reduce cost sharing could increase adherence to recommended preventive services such as colonoscopy examinations.
AB - Background & Aims: Economic factors might affect the use of recommended preventative services. We sought to determine whether the recent severe economic recession was associated with diminished screening colonoscopy rates among an insured population and to assess the relationship between out-of-pocket (OOP) costs and screening colonoscopy use. Methods: Administrative data from 106 health plans (IMS LifeLink Health Plan Claims Database) were analyzed to determine monthly rates of screening colonoscopies performed on beneficiaries ages 50 to 64 years between January 2005 and November 2007 (prerecession), as well as from December 2007 through June 2009 (recession). Segmented regression models were used to evaluate changes in screening colonoscopy rates, as well as the relationship between screening and OOP costs before and during the recession. Results: Compared with prerecession trends, during the recession screening colonoscopy rates decreased by 68.9 colonoscopies/1 million individuals per month (95% confidence interval, -84.6 to -53.1; P < .001). Application of study estimates to the entire US population indicated that during the recession, commercially insured patients aged 50 to 64 years underwent approximately 500,000 fewer screening colonoscopies. Compared with those with low OOP costs, those with high OOP procedure costs had lower rates of screening before and during the recession, and had a greater reduction in screening rates during the recession (P = .035). Conclusions: During the recession of December 2007 to June 2009, insured individuals reduced their use of screening colonoscopy compared with the 2 years before the recession began. OOP costs were related inversely to screening use, especially during the recession. Policies to reduce cost sharing could increase adherence to recommended preventive services such as colonoscopy examinations.
KW - Colon Cancer
KW - Colorectal Cancer
KW - Health Care Spending
KW - Prevention
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U2 - 10.1016/j.cgh.2011.11.020
DO - 10.1016/j.cgh.2011.11.020
M3 - Article
C2 - 22155558
AN - SCOPUS:84857194504
SN - 1542-3565
VL - 10
SP - 278
EP - 284
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -