Nearly a quarter of U.S. women continue to have out-of-pocket costs for screening mammography, despite the fact that the Affordable Care Act of 2010 (ACA) removed cost-sharing barriers for such preventive services, according to a study published online September 28 in the Journal of Women's Health.
And it's possible that these out-of-pocket payments could negatively affect screening compliance, wrote a team led by Dr. Susan Sabatino of the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta.
"Even relatively small co-payments have been associated with lower mammography use in some groups. ... Eliminating cost sharing has been associated with increased screening use, or slower declines in use," the researchers wrote.
Still uninsured
Even with the passage of the ACA almost a decade ago, some women remain uninsured. Sabatino's group sought to investigate the incidence of payment for mammography screening and whether it varied across certain groups of women.
The authors used 2015 National Health Interview Survey data to explore whether 3,278 women ages 50 to 74 years who had screening mammography within the previous year had reported paying anything for mammograms. They also assessed out-of-pocket payments based on demographic and insurance factors by age cohorts (50-64 years and 65-74 years).
Most of the study participants were between 50 and 64, white, privately insured, and born in the U.S. Most also had more than a high school education and income well over the federal poverty level. Only 3% of all women included in the study did not have insurance.
Sabatino and colleagues found that the majority of women across both age groups did not report any out-of-pocket costs for screening mammography; however, almost a quarter of women between the ages of 50 and 64 did (23.5%). Of these, 20.5% paid part of the cost and 3% paid all of it. In addition, 39.1% of uninsured women between the ages of 50 and 64 reported out-of-pocket payments, while 25.6% of privately insured women in this age group did.
Women between the ages of 65 and 74 were less likely to have screening mammography payments, the researchers found.
| Incidence of screening mammography payment by insurance status | ||
| Insurance | Women 50-64 who paid out-of-pocket costs | Women 65-74 who paid out-of-pocket costs |
| Private | 25.6% | NA |
| Private + Medicare | NA | 12.1% |
| Medicare only | NA | 22.5% |
| Medicare Advantage | NA | 10% |
| Medicaid | 5% | NA |
| Other coverage | 13.7% | NA |
| Uninsured | 39.1% | NA |
| Total | 23.5% | 11.9% |
"In [our analysis], only insurance was significantly associated with paying any cost for mammography, and it was significant in both age-specific models," the group noted.
More work to be done
Even though most women did not have screening mammography copays in 2015, more than 20% did, which suggests there's more work to be done in evaluating how out-of-pocket healthcare expenses may affect screening mammography. Women who encounter cost barriers could benefit from programs that provide mammograms at reduced or no cost, such as the CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the team wrote.
"Paying at least some of the cost was reported by > 20% of women aged 50 to 64 years and women aged 65 to 74 years with Medicare only, and by almost 40% of younger uninsured women," Sabatino and colleagues concluded.
"Continued efforts are needed to monitor cost sharing and to assess the impact of changes in cost sharing on screening use and disparities," they wrote.
