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Does Health Insurance Coverage of Office Visits Influence Colorectal Cancer Testing?

¹ Epidemic Intelligence Service Program, ² Epidemiology Program Office, and ³ Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and ⁴ Health Care Initiatives Unit, General Motors Corporation, Detroit, Michigan

Requests for reprints: Carol Friedman, Surveillance Research Section, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-53, Atlanta, GA 30341. Phone: 770-488-3180; Fax: 770-488-4759. E-mail: cxf7{at}cdc.gov

Objective: To assess the effect of differing health insurance coverage of physician office visits on the use of colorectal cancer (CRC) tests among an employed and insured population.

Method: Cohort study of persons ages 50 to 64 years enrolled in fee-for-service (FFS) or preferred provider organization (PPO) health plans, where FFS plan enrollees bear disproportionate share of office visit coverage, for the period 1995 through 1999.

Results: Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain CRC tests [adjusted relative risk (RR_a), 1.27; 95% confidence intervals (CI), 1.21-1.24]. The association was more pronounced among hourly individuals (RR_a, 1.43; 95% CI, 1.41-1.45) than among salaried individuals (RR_a, 1.09; 95% CI, 1.05-1.10), consistent with a greater differential in office visit coverage among the hourly group.

Conclusions: Disproportionate cost-sharing seems to have a negative effect on the use of CRC tests most likely by discouraging nonacute care physician office visits.

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