Title |
Current National Health Insurance Coverage Policies for Breast and Ovarian Cancer Prophylactic Surgery
|
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Published in |
Annals of Surgical Oncology, April 2000
|
DOI | 10.1007/s10434-000-0325-1 |
Pubmed ID | |
Authors |
Henry M. Kuerer, E. Shelley Hwang, James P. Anthony, R. Adams Dudley, Beth Crawford, Wade M. Aubry, Laura J. Esserman |
Abstract |
The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in high-risk women. Because cost has become central to medical decision-making, this study was designed to evaluate currently existing coverage policies for these procedures. A confidential detailed cross-sectional nationwide survey of 481 medical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted. Of the 150 respondents, 65% (n = 97) had 100,000 or more enrolled members and 35% (n = 53) had fewer than 100,000 enrolled members. Only 44% of private plans have specific policies for coverage of prophylactic mastectomy for a strong family history of breast cancer and 38% of plans for a BRCA mutation. Only 20% of total responding plans had a policy for coverage of prophylactic oophorectomy under any clinical circumstance. Governmental carriers were significantly less likely to have any policy for prophylactic surgery (range, 2%-12%) compared with nongovernmental plans (range, 24%-44%; P < .001). No significant regional differences for coverage policies were identified (P > .05). Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 1 | 4% |
Unknown | 27 | 96% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Ph. D. Student | 5 | 18% |
Other | 4 | 14% |
Researcher | 3 | 11% |
Student > Doctoral Student | 2 | 7% |
Professor | 2 | 7% |
Other | 5 | 18% |
Unknown | 7 | 25% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 6 | 21% |
Nursing and Health Professions | 5 | 18% |
Social Sciences | 3 | 11% |
Economics, Econometrics and Finance | 2 | 7% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 4% |
Other | 3 | 11% |
Unknown | 8 | 29% |