Does Health Insurance Coverage of Office Visits Influence Colorectal Cancer Testing?

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Abstract
Objective: To assess the effect of differing health insurance coverage of physician office visits on the use of colorectal cancer (CRC) tests among an employed and insured population. Method: Cohort study of persons ages 50 to 64 years enrolled in fee-for-service (FFS) or preferred provider organization (PPO) health plans, where FFS plan enrollees bear disproportionate share of office visit coverage, for the period 1995 through 1999. Results: Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain CRC tests [adjusted relative risk (RRa), 1.27; 95% confidence intervals (CI), 1.21-1.24]. The association was more pronounced among hourly individuals (RRa, 1.43; 95% CI, 1.41-1.45) than among salaried individuals (RRa, 1.09; 95% CI, 1.05-1.10), consistent with a greater differential in office visit coverage among the hourly group. Conclusions: Disproportionate cost-sharing seems to have a negative effect on the use of CRC tests most likely by discouraging nonacute care physician office visits.