Copay may be a deterrent to getting mammograms.

Small insurance copayments are enough of a deterrent to keep many older women from getting mammograms to detect breast cancer, according to a recent study.

The study looked at 174 Medicare managed-care plans insuring 366,475 women aged 65-69 years. During the four-year period studied, the number of plans requiring a copayment for a mammogram rose to 21 in 2004 from 3 in 2001. Screening rates were 8.3% lower for women in insurance plans requiring a copay than in plans that picked up the full cost of mammograms. Most copays were $20, but the amounts ranged from $12.50-$35.

The researchers said that managed-care plans would be wise to exempt older women from mammogram copayments because breast cancer is less expensive to treat when caught early. The study bolsters the idea of "value-based insurance" in which insurers lower copays and other costs to patients as a way to promote the use of tests and drugs that are proven to be cost effective in the long run.

Trivedi, A.N., Rakowski, W., & Ayanian, J.Z. (2008). Effect of cost sharing on screening mammography in Medicare health plans. New England Journal of Medicine, 358(4), 375-383.

Deborah McBride, RN, MSN, CPON[R], Contributing Editor

Contributing Editor Deborah McBride, RN, MSN, CPON[R], is a nurse at the Kaiser Permanente Oakland Medical Center and a faculty member at Samuel Merritt College in Oakland, CA.