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Am J Prev Med. 2019 May;56(5):e143-e152. doi: 10.1016/j.amepre.2019.01.005.

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

Author information

1
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.
2
Department of Clinical Sciences, Parkland Health and Hospital System/University of Texas Southwestern Medical Center, Dallas, Texas; Department of Population Sciences, Simmons Comprehensive Cancer Center, Dallas, Texas.
3
Department of Biostatistics, Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
4
Department of Clinical Sciences, Parkland Health and Hospital System/University of Texas Southwestern Medical Center, Dallas, Texas.
5
Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
6
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
7
Department of Family Medicine and Community Health, Perelman School of Medicine, Universityof Pennsylvania, Philadelphia, Pennsylvania.
8
Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California.
9
Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
10
Office of Disease Prevention, NIH, Bethesda, Maryland.

Abstract

INTRODUCTION:

The 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.

METHODS:

A 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.

RESULTS:

Even 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.

CONCLUSIONS:

This 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.

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