Lower Deductibles Linked to Increases in Preventive Screenings

Providing first-dollar coverage for primary preventive screenings appears to increase utilization of screenings, according to an observational study released Friday from Health Services Research. However, the finding raises questions about the impact of such coverage on those in high-deductible health plans (HDHP).

Investigators analyzed preventive screening use among 44,106 individuals enrolled in a PPO through a large multinational company between 2001 and 2006. The plans waived deductibles for four tests (lipid screening, mammography, fecal occult blood testing, and pap smears).

First-dollar coverage resulted in a moderate increase (2.3-7.8 percent) in the screenings. Between 23 (mammography) and 78 (pap smears) more patients per 1,000 enrollees received screens after the policy change. Rates were unchanged among a control group of 60,107 individuals enrolled in a low-deductible PPO. (Endoscopy was not made deductible-free; rates did not increase in either group.)

However, among those with HDHPs the increase was smaller than for the entire cohort, reports Daniella Meeker, Ph.D., information scientist at the RAND Corporation.  "Waiving deductibles alone may not be sufficient to encourage enrollees to seek preventive services."