Impact of the 2008–2009 Economic Recession on Screening Colonoscopy Utilization Among the Insured

Abstract

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 (LifeLink™ Health Plan Claims Database) were analyzed to determine monthly rates of screening colonoscopies performed on 50–64 year old beneficiaries between January 2005 and November 2007 (pre-recession), as well as 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 to pre-recession trends, during the recession screening colonoscopy rates decreased by 68.9 colonoscopies/1,000,000 individuals per month (95% confidence interval, decreased of 84.6–53.1; P<.001). Application of study estimates to the entire US population indicated that during the recession, commercially insured, 50–64 year olds underwent approximately 500,000 fewer screening colonoscopies. Compared to 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–June 2009, insured individuals reduced their use of screening colonoscopy, compared with the 2 years before the recession began. OOP costs were inversely related to screening use, especially during the recession. Policies to reduce cost sharing could increase adherence to recommended preventive services such as colonoscopy examinations.

Medicare Cancer Screening in the Context of Clinical Guidelines

“…For example, it is not possible with this data to determine the extent to which the macroeconomic events impacted screening rates. Although prior reports have implicated the 2007 financial crisis as a contributor to the recent decline in screening, 66 our data suggest that less aggressive screening guidelines may have also played a role. This is consistent with an analysis from the Congressional Budget Office that concluded that a general slowing in Medicare FFS expenditure growth from 2007 to 2010 compared with 2000 to 2005 was mostly unexplained by recession effects, and that Medicare FFS health care utilization is largely independent of personal wealth.…”

Young-Onset Colorectal Cancer: Earlier Diagnoses or Increasing Disease Burden?

“…28 Indeed, 500,000 fewer screening colonoscopies were performed among adults aged 50–64 years during the recession than would have been expected based on trends before the recession. 29 Downstream economic effects of the recession may have also affected patients’ willingness to see providers and ability to afford (expensive) colonoscopy copayments. Around the same time, health care reform emphasized high-value care and penalized unnecessary medical tests and procedures.…”

Breast and Cervical Screening by Race/Ethnicity

“…5 Consistent with prior recessions in American history, these economic shifts resulted in a reduction in health services utilization among the general population. 1 , 5 , 6 , 7 …”