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By Katherine Hobson By a number of indicators, people have been using fewer medical services during the economic downturn. Screening colonoscopies apparently aren’t immune to that trend, according to a study appearing in the March issue of Clinical Gastroenterology and Hepatology. The study finds that during the recent recession, commercially insured Americans had fewer of the tests to screen for cancer — a test that saves lives, according to research published just this week. According to the analysis, there were about 500,000 fewer screening colonoscopies among commercially-insured people aged 50 to 64 than you’d expect during the most recent recession, which officially lasted from December 2007 to June 2009. (The study used the National Bureau of Economic Research’s official designation for the recession.) The U.S. Preventive Services Task Force recommends colorectal cancer screening using several methods, including colonoscopy, for adults aged 50 to 75. The analysis didn’t find that people forgoing colonoscopy were instead using other, cheaper methods, such as fecal occult blood tests or sigmoidoscopy. Researchers looked at the rates of screening before and after the recession, then applied their findings to population data to come up with an estimate of 516,309 colonoscopies that would have occurred absent the downturn. Data came from 106 health plans and added up to a nationally representative picture of the commercially insured population, the authors say. It doesn’t include people who didn’t have a screening colonoscopy because they lost insurance coverage during the recession, says Spencer Dorn, an author of the study and an assistant professor of medicine in the division of gastroenterology at the University of North Carolina at Chapel Hill. And it doesn’t include Medicare or Medicaid beneficiaries. The analysis also found that when it comes to colonoscopy, cost sharing appears to be a deterrent. No matter the economic climate, people with higher out-of-pocket costs — $300 or more for the procedure — were less likely to be screened than those with lower costs, defined as $50 or less. That gap “widened during the recession,” says Dorn. Under the health-care overhaul law, colonoscopy — and other preventive services — must be covered with no cost sharing by Medicare, Medicaid and new private-insurance plans. (“Grandfathered” plans that haven’t significantly changed their design are exempt.) The drop in utilization seen in the study “could have negative consequences down the line,” says Dorn, in terms of cancers being caught at a later stage. (The screening study out this week suggests it might also lead to deaths from the disease.) The CDC last year reported an increase in screening rates for colorectal cancer from 2002 to 2010, but that estimate included all 50- to 75-year-olds and didn’t break down what happened during the intervening years.
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