The Impact of Consumer-Directed Health Plans and Patient Socioeconomic Status on Physician Recommendations for Colorectal Cancer Screening

Pollack, Craig Evan; Mallya, Giridhar; Polsky, Daniel

doi:10.1007/s11606-008-0714-x

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…[23][24][25] HDHP enrollees are more likely to forgo preventative care and are less adherent to medications for chronic health conditions. [26][27][28][29][30] These financial barriers to seeking, obtaining, and adhering to medical care will undoubtedly be exacerbated in the presence of additional health needs that are likely to arise in the aftermath of COVID-19 infection and the financial hardship that many in the USA may experience after a period of unemployment or underemployment.…”

Section: Potential Long-term Complications Of Covid-19mentioning

confidence: 99%

Planning for the Post-COVID Syndrome: How Payers Can Mitigate Long-Term Complications of the Pandemic

Jiang

McCoy

2020

J GEN INTERN MED

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As the COVID-19 pandemic continues to unfold, payers across the USA have stepped up to alleviate patients' financial burden by waiving cost-sharing for COVID-19 testing and treatment. However, there has been no substantive discussion of potential long-term effects of COVID-19 on patient health or their financial and policy implications. After recovery, patients remain at risk for lung disease, heart disease, frailty, and mental health disorders. There may also be long-term sequelae of adverse events that develop in the course of COVID-19 and its treatment. These complications are likely to place additional medical, psychological, and economic burdens on all patients, with lower-income individuals, the uninsured and underinsured, and individuals experiencing homelessness being most vulnerable. Thus, there needs to be a comprehensive plan for preventing and managing post-COVID-19 complications to quell their clinical, economic, and public health consequences and to support patients experiencing delayed morbidity and disability as a result.

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Section: Potential Long-term Complications Of Covid-19mentioning

confidence: 99%

Planning for the Post-COVID Syndrome: How Payers Can Mitigate Long-Term Complications of the Pandemic

Jiang

McCoy

2020

J GEN INTERN MED

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“…However, treatment decisions are made largely by physicians. Whether or not physicians are aware of patient cost-sharing and how they would react to that knowledge are extremely important areas of concern (44).…”

Section: Cost-sharing Mechanismsmentioning

confidence: 99%

Cost-Sharing: A Blunt Instrument

Remler

Greene

2009

Annu. Rev. Public Health

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Cost-sharing is a health care cost-containment technique in which health care services are partially paid for by patients out of pocket. Costsharing can reduce non-cost-effective care, but it can also undermine the financial protection and access values of health insurance. We review the empirical evidence published since the mid-1980s about cost-sharing's effect on utilization, expenditures, health, and adverse consequences, including how the effects vary by form of care, by health status, and by sociodemographic characteristics. Some cost-sharing, such as emergency department copayments, reduces utilization without any harmful effects, whereas other cost-sharing reduces valuable care such as maintenance drug use among the chronically ill. Cost-sharing should be used judiciously, with attention taken not to reduce highly cost-effective care.

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“…10,19,20 Even screening recommendations for cancer appear to be affected by SES and insurance payer factors, such as deductible. 21 If procedural designation as elective and the APR-DRG Severity index can be taken as measures of disease stage at presentation for sigmoidectomy, then our data indicate that there are significant differences in stage of presentation between those in the lowest and highest income quartiles.…”

Section: Discussionmentioning

confidence: 73%

Economic Disparities in Patients Undergoing Sigmoidectomy

Neifert

Ilonzo

et al. 2018

JSLS

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Background and Objectives:Disparities in health care outcomes and resources utilized are present in the treatment of many conditions and represent an area for targeted improvement. This study analyzes the differences in outcomes and total hospital charges between the highest and lowest income quartiles of patients undergoing sigmoid colectomy.Methods:This retrospective cohort study included patients undergoing sigmoid colectomy from 2013 to 2014 queried from the Agency for Healthcare Research and Quality National Inpatient Sample Database who were categorized as the lowest and highest income quartile based on average income of the patient's ZIP code. Patients were grouped into income quartiles, as defined by average income in the ZIP code of residence. In-hospital complications were the primary outcome of this study. We hypothesized that patients in the lowest income quartile would have poorer outcomes than those in the highest income quartile prior to data collection.Results:The lowest (n = 40,995) and highest (n = 40,940) income quartiles are not significantly different based on age or gender. The lowest income quartile was sicker, with higher mean scores for the All Patient Refined Diagnosis Related Group Severity Index and All Patient Refined Diagnosis Related Group Risk of Mortality Index. The lowest income quartile cohort had higher rates of postoperative complications and higher total charges than those in the highest income quartile. Adjusted regression analysis showed significantly lower total charges for the lowest income quartile but no significant differences in overall complications, mortality rates, or nonhome discharge.Conclusions:Patients in the highest income quartile utilize more hospital resources than the lowest income quartile. Additional study is required to understand why these differences exist.Key Points:1. Significant differences in outcomes and hospital charges exist between socioeconomic groups undergoing sigmoidectomy. 2. There does not seem to be a difference in outcomes after sigmoidectomy among different socioeconomic groups. 3. Elective and laparoscopic sigmoid colectomy is more frequently applied to higher socioeconomic groups. 4. Hospital charges are also greater among patients of higher socioeconomic groups undergoing sigmoid colectomy.Question:Does socioeconomic status affect outcomes and total charges in patients undergoing sigmoid colectomy?Findings:Unadjusted analysis showed significant disparities between the highest and lowest income quartile in outcomes after sigmoid colon resection. Adjusted analysis showed no difference in outcomes, with patients in the highest income quartile having higher total charges.Meaning:There is a value difference between high-income and low-income patients undergoing sigmoid colectomy.

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The Impact of Consumer-Directed Health Plans and Patient Socioeconomic Status on Physician Recommendations for Colorectal Cancer Screening

Abstract: Patient SES and deductible-level affect physician recommendations for preventive care. Coverage of preventive services and funds in medical savings accounts may help to mitigate the impact of high-deductibles and SES on inappropriate recommendations.

Cited by 15 publications

References 33 publications

Planning for the Post-COVID Syndrome: How Payers Can Mitigate Long-Term Complications of the Pandemic

Planning for the Post-COVID Syndrome: How Payers Can Mitigate Long-Term Complications of the Pandemic

Cost-Sharing: A Blunt Instrument

Economic Disparities in Patients Undergoing Sigmoidectomy

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