Potential Impact of Loss of Coverage for Health Care Screenings: Constance Blunt, MD

Screening coverage is not just about medical tests, but about maintaining patient trust, reducing long-term health care costs, and ensuring accessible preventive care, says Constance Blunt, MD, medical oncologist, Mary Bird Perkins Cancer Center.

This transcript was lightly edited; captions were auto-generated.

Transcript

If insurance plans could eliminate free preventive screenings (employer or Medicaid), do you anticipate there would be fewer screenings? What kind of impact would this have?

I think it would really be a problem. A lot of our patients do rely on this coverage to get these screenings. If we don't have that, then now we're kind of relying on our philanthropy and a limited number of funds to be able to still provide financially free or low-cost screenings for patients. If we lose coverage in one area, then we have to really work hard to make up for it in another area to not lose patients, to be able to still cover and screen a large group of patients. It would have a significant impact.

I think patients would have to make choices as to what they could afford, and maybe delay or avoid screening and cover services that are more, I guess, crucial to them day to day. If a patient has to pick between paying for their blood pressure medication or coming in and paying the co-pay for their mammogram, they're probably going to choose that essential medication that they take every day. And so, it seems like kind of a small thing, but it has ripples across the entire health care spectrum.

And the other thing to think about is, it's not just the screenings that are covered. If patients don't get screened and they do have a problem, we find it later—that's another increase in financial burden, number of appointments, number of treatments. And so I feel like early detection is so important—not just because it saves lives, but it also has a big financial impact. Financial toxicity is huge in the care of cancer. Some families have been forced to spend their savings, their retirement, to kind of cover these costs. Imagine the cost savings: finding someone who has a finite number of treatments for early-stage disease vs someone who comes to us metastatic, where the treatment is over a period of months, even years for some patients. A simple screening really can make a big difference.

If health systems are telling patients that certain screenings are free, and in the future the patient had to pay, how would this affect trust between the health system and patients?

I think it significantly impacts a patient's trust. Number one, there's so much information out there for patients to receive—they never know what's true, what's false. And so they're going in to their primary doctors who are ordering these things, and that's where a lot of this is resolved. And so, for a patient who's established with this clinic, with this doctor, to have a routine and to know that I can reliably get my mammogram at no cost every year, to all of a sudden be told it can't happen—they're going to want to know why. And there's going to be this kind of balance where we're forced to explain.

Because a lot of patients think that their clinics, their doctors—we can fix everything. We have the solution. The doctor is where the answer is going to be found. And so I rely heavily on our support staff, on our financial services, to be able to maneuver patients' insurance and coverage so that we're maximizing their benefits and keeping their out-of-pocket costs low. And if that changes, that patient is going to feel that. And sometimes it kind of hurts. They take these decisions personally, not realizing that these are rules and guidelines that are kind of out of our hands.

And so I think it would not help these established, trusted relationships to have to regroup and remaneuver what they've been programmed to do or what they have come to expect all of these years.