The Impact of Medicare Health Insurance Coverage on Lung Cancer Screening. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Sun, Jiren; Perraillon, Marcelo Coca; Myerson, Rebecca
• Is Part Of: Medical care. Volume 60:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: lung cancer -- computed tomography -- screening -- Medicare -- smoking; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001655
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. Objective: The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. Research Design: A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk. Subjects: A total of 11, 163 individuals at high risk for lung cancer just above and below age 65. Measure: Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months. Results: A total of 10, 951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%–30.0%, P =0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: −19.8% to 23.0%, P =0.88). Conclusions: Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening. Abstract : Supplemental Digital Content is available in the text.