Varghese Reuben K, Friedman Carol, Ahmed Faruque, Franks Adele L, Manning Marsha, Seeff Laura C
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Cancer Epidemiol Biomarkers Prev. 2005 Mar;14(3):744-7. doi: 10.1158/1055-9965.EPI-04-0477.
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.
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.
Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain CRC tests [adjusted relative risk (RR(a)), 1.27; 95% confidence intervals (CI), 1.21-1.24]. The association was more pronounced among hourly individuals (RR(a), 1.43; 95% CI, 1.41-1.45) than among salaried individuals (RR(a), 1.09; 95% CI, 1.05-1.10), consistent with a greater differential in office visit coverage among the hourly group.
Disproportionate cost-sharing seems to have a negative effect on the use of CRC tests most likely by discouraging nonacute care physician office visits.
评估在就业且参保人群中，不同的医生门诊医疗保险覆盖范围对结直肠癌（CRC）检查使用情况的影响。
对1995年至1999年期间参加按服务收费（FFS）或优先提供者组织（PPO）健康计划的50至64岁人群进行队列研究，其中FFS计划参保者承担了不成比例的门诊覆盖费用。
与FFS计划相比，PPO计划参保者进行CRC检查的可能性显著更高[调整后相对风险（RR(a)）为1.27；95%置信区间（CI）为1.21 - 1.24]。这种关联在小时工中（RR(a)为1.43；95% CI为1.41 - 1.45）比在 salaried 个体中（RR(a)为1.09；95% CI为1.05 - 1.10）更为明显，这与小时工群体在门诊覆盖方面存在更大差异一致。
费用分担不成比例似乎对CRC检查的使用产生负面影响，很可能是通过抑制非急性护理的医生门诊就诊来实现的。
