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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

Office of Science Planning, Policy, Analysis, Reporting and Data, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland. Electronic address:
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.
Department of Biostatistics, Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Department of Clinical Sciences, Parkland Health and Hospital System/University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Department of Family Medicine and Community Health, Perelman School of Medicine, Universityof Pennsylvania, Philadelphia, Pennsylvania.
Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California.
Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Office of Disease Prevention, NIH, Bethesda, Maryland.



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.


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.


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.


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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