Co-pay hurts mammogram rate

Requiring even a small co-payment dramatically reduces the likelihood that women will get regular mammograms to detect breast cancer.

Screening rates from 2001 through 2004 were nearly 11% lower for women who had to contribute a co-pay as low as $12, compared with women whose breast X-rays were free, researchers from Brown and Harvard universities report in the Jan. 24 issue of the New England Journal of Medicine.

They surveyed more than 366,000 women ages 65 to 69.

“I think it’s a surprising result,” said Dr. Amal Trivedi of Brown, who led the study. “Most people would consider $12 to be a rather modest sum. But when it came to this population, co-payments as low as $12 led to a very sharp decrease in the breast cancer screening rate.”

Studies have suggested that mammograms may save lives by detecting breast cancers at an earlier, and more curable, stage. “This is a case where co-payments adversely affected health,” Trivedi said in a telephone interview.

Breast cancer is more difficult -- and more expensive -- to treat at its later stages.

“It would make clinical sense, and probably economic sense, for a health plan to eliminate a co-payment for a mammogram,” Trivedi said.