The New York Times-20080129-Co-Pays Seen as a Deterrent To Getting Mammograms

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Co-Pays Seen as a Deterrent To Getting Mammograms

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When it comes to medical fees, $12 may not seem much, but it is enough to deter many women from getting a mammogram, a new study finds.

Writing in the Jan. 24 New England Journal of Medicine, researchers say that when insurance plans require patients to make co-payments of $12 to $35 for mammograms, many decide to take a pass. This finding was true even when factors like income and education were taken into account.

What it means, the study said, is that more women may develop breast cancer that is not found until it is harder to treat.

The researchers, led by Dr. Amal N. Trivedi of Brown University, reviewed mammogram coverage by 174 Medicare managed-care plans affecting more than 350,000 women ages 65 to 69.

On average, the screening rate for women who were required to make co-payments was about 8 percent lower than for women with full coverage. But as they looked closer, the researchers found even more evidence of the co-payments' effect.

Under insurance plans that added mammogram co-payments during the course of the study, for example, there was a 6 percent drop in screening in just two years. During that same time, mammogram rates rose 3 percent in plans that kept their no-co-payment policy.

As a matter of public health, Dr. Trivedi said, the reason for ending such co-payments is simple. We should do it because it is the right thing to do, he said. As a practical matter, he said, it may cost insurance companies less in the future by catching cancers earlier.