Health insurance reimbursement may determine cancer screening rates

A study published today indicates that people living in American states that offer higher Medicaid payments for office visits are more likely to have been screened for breast, cervical, and colorectal cancers than those in states giving lower levels of Medicaid support.

Although the general requirements of the Medicaid health insurance programme are set by the federal government, each state individually decides its own Medicaid policies determining how much providers are paid for healthcare services and who is eligible for Medicaid. The effects of state-specific differences in Medicaid policies on the use of preventive care services, and particularly early detection of cancer, have not been thoroughly assessed to date.

The current study, led by Michael Halpern of RTI International, analysed Medicaid data and cancer screening rates from 46 states and Washington DC.

Dr Halpern explained “Our study was able to compare differences in cancer screening for Medicaid beneficiaries in almost all states, providing a broad, national picture of the effects of state-level Medicaid policies.”

The results showed that the recommended screenings for early detection of breast, cervical, and colorectal cancer were more likely to have been undertaken among Medicaid beneficiaries living in states with higher payments for office visits. However, states providing higher Medicaid payments for cancer screening tests (such as colonoscopy, mammography, and Pap tests) did not always have higher screening rates.

Lower cancer screening rates were also found among Medicaid beneficiaries in states using the 'asset test' (which considers an individual’s savings, property, and other items of worth) to determine an individual's eligibility to enrol in Medicaid.

The results suggest that, among Medicaid beneficiaries, lower cancer screening rates are a consequence of financial barriers to accessing primary care physicians rather than the cost of the screening tests themselves.

It thus appears that an increase in the likelihood of individuals enrolled in Medicaid undergoing cancer screening would be best achieved by increasing reimbursements for office visits, thereby facilitating access to primary care.

Elimination of asset tests may further increase the likelihood of receiving cancer screenings by helping low-income individuals remain enrolled in Medicaid.

Dr Halpern explained that “Due to multiple factors, including Health Care Reform and decreased state budgets, many states are changing their Medicaid policies, including how much health care providers are paid and who is allowed to enrol”.

The results of this study could therefore help state healthcare decision makers revise Medicaid policies in order to address barriers to accessing care and consequently the uptake of recommended cancer screening services.


Halpern MT, et al. Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening. Cancer 2014. E-pub before print 25 August.

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