Cancer screening is one of the controversial aspects of health care; America has long had a 'defensive medicine' problem, where in some cases doctors and hospitals run many unnecessary tests to check off the boxes so that if something does go wrong, lawyers won't be shedding tears in court about how the greedy or incompetent medical community ruins lives.

Then in other cases doctors may be running tests with little value because the effect on patients is psychological or it won't be meaningful, such as in cancer screening for the elderly. 

Then there is the issue where it's good business. 

A recent study in CANCER has found that in states with higher Medicaid payments for office visits, Medicaid beneficiaries were more likely to be screened for breast, cervical, and colorectal cancer. 

Medicaid is a health insurance program controlled by the federal government, but each state has to help pay for it and they set how much providers are paid for health care services and who is allowed to enroll. To see if state Medicaid eligibility and reimbursement policies affect receipt of breast, cervical, and colorectal cancer screening among Medicaid beneficiaries, Michael Halpern, MD, PhD, MPH, of RTI International, and colleagues analyzed 2,007 Medicaid data from 46 states and Washington DC.

They found that in states with higher payments for office visits, Medicaid beneficiaries were more likely to receive recommended screenings for early detection of all three types of cancer. In contrast, higher payments for cancer screening tests (such as colonoscopy, mammography, and Pap tests) were not always linked with increased screenings among Medicaid beneficiaries.

The team also found that Medicaid beneficiaries in states that had an “asset test” (which considers an individual’s savings, property, or other items of worth to determine whether he or she could enroll in Medicaid) were less likely to be screened for cancer.

The association between higher Medicaid reimbursements for office visits and increased likelihood of receiving cancer screenings may reflect barriers in access to primary care physicians and other providers for Medicaid enrollees in states with lower reimbursements. Increasing reimbursements for office visits may facilitate access to primary care among Medicaid beneficiaries, and thereby increase the likelihood of receiving appropriate cancer screening tests.

On the other hand, raising reimbursement for the screening tests themselves may be a less effective policy tool for increasing use of recommended screenings. The results also indicate that eliminating asset tests may increase the likelihood of receiving cancer screenings by helping low-income individuals remain enrolled in Medicaid.

“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 enroll,” said Halpern. “Our findings can help state health care decision makers and policy leaders to develop new Medicaid policies that aid low income individuals in receiving recommended cancer screenings.”

Citation: “Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening.” Michael T. Halpern, Melissa A. Romaire, Susan G. Haber, Florence K. Tangka, Susan A. Sabatino, and David Howard. CANCER; Published Online: August 25, 2014 DOI: 10.1002/cncr.28704.