• Am J Prev Med · May 2019

    Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type.

    • Nancy Breen, Celette Sugg Skinner, Yingye Zheng, Stephen Inrig, Douglas A Corley, Elisabeth F Beaber, Mike Garcia, Jessica Chubak, Chyke Doubeni, Virginia P Quinn, Jennifer S Haas, Christopher I Li, Karen J Wernli, Carrie N Klabunde, and PROSPR consortium.
    • Office of Science Planning, Policy, Analysis, Reporting and Data, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland. Electronic address: breenn@mail.nih.gov.
    • Am J Prev Med. 2019 May 1; 56 (5): e143-e152.

    IntroductionThe purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same healthcare systems.MethodsA total of 35,009 patients aged 50-64years with a positive fecal immunochemical test were evaluated in Northern and Southern California Kaiser Permanente systems and in a North Texas safety-net system between 2011 and 2012. Kaplan-Meier estimation was used between 2016 and 2017 to calculate the probability of having follow-up colonoscopy by coverage type. Among Kaiser Permanente patients, Cox regression was used to estimate hazard ratios and 95% CIs for the association between coverage type and receipt of follow-up, adjusting for sociodemographics and health status.ResultsEven within the same integrated system with organized follow-up, patients with Medicaid were 24% less likely to complete follow-up as those with commercial insurance. Percentage receiving colonoscopy within 3 months after a positive fecal immunochemical test was 74.6% for commercial insurance, 63.10% for Medicaid only, and 37.5% for patients served by the integrated safety-net system.ConclusionsThis study found that patients with Medicaid were less likely than those with commercial insurance to complete follow-up colonoscopy after a positive fecal immunochemical test and had longer average times to follow-up. With the future of coverage mechanisms uncertain, it is important and timely to assess influences of health insurance coverage on likelihood of follow-up colonoscopy and identify potential disparities in screening completion.Copyright © 2019. Published by Elsevier Inc.

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