Office of Science Planning, Policy, Analysis, Reporting and Data, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland.
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.
Am J Prev Med. 2019 May;56(5):e143-e152. doi: 10.1016/j.amepre.2019.01.005.
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.
本研究旨在检验如下假设，即在同一医疗体系中，与拥有商业保险的患者相比，拥有医疗补助保险或类似医疗补助保险覆盖的患者进行结肠镜检查的随访时间更长，且更不可能完成结肠镜检查。
2011 年至 2012 年，在加利福尼亚州北部和南部的 Kaiser Permanente 系统以及德克萨斯州北部的一个医疗保障安全网系统中，对 35009 名年龄在 50-64 岁之间、粪便免疫化学检测呈阳性的患者进行了评估。2016 年至 2017 年，使用 Kaplan-Meier 估计来计算不同保险类型的患者接受随访结肠镜检查的概率。在 Kaiser Permanente 的患者中，使用 Cox 回归来估计保险类型与接受随访之间的关联的风险比和 95%置信区间，同时调整社会人口统计学和健康状况因素。
即使在具有组织性随访的同一综合体系内，拥有医疗补助的患者完成随访的可能性也比拥有商业保险的患者低 24%。粪便免疫化学检测呈阳性后 3 个月内接受结肠镜检查的患者比例分别为商业保险 74.6%、仅医疗补助 63.10%和综合安全网系统患者 37.5%。
本研究发现，与拥有商业保险的患者相比，拥有医疗补助的患者在粪便免疫化学检测呈阳性后更不可能完成随访结肠镜检查，且他们的平均随访时间更长。由于未来的保险机制尚不确定，因此评估医疗保险覆盖范围对后续结肠镜检查可能性的影响以及确定筛查完成情况方面的潜在差异非常重要且及时。
