Thursday, September 10, 2015

Paying women to get mammograms

What to do, what to do
My health plan offered me a $15 gift card to get my mammogram. These payments can range up to $250--the theory being that insurance cos may pay out less in the long run if they can catch breast cancer early.

Harald Schmidt, PhD, an assistant prof of Medical Ethics & Health Policy at the Perelman School of Medicine (Univ of Penn), draws a distinction between paying people to get weight loss or smoking cessation therapy. Incentives support behavior change there.

But he says breast cancer is different. Women need to weigh a lot of variables of benefits and risks.

Screening only reduces chances of dying from breast cancer--screened women do die.

Some cancers identified never develop into lethal forms. The mammogram can lead to over-treatment.

All participants face periods of worry due to false positives and biopsy complications.

The U.S. Preventive Service Task Force's guidelines recommend mammos every two years for average-risk women 50-74. For ages 40-49, there is moderate certainty net benefit is small.

Women receiving brochures and information (this should be incentivized, not the mammos, Schmidt says) are less likely to be screened.

Incentives should support and not distract from informed decision-making, he says.

So what is the bottom line here? Decide for yourself--knowledge of the incidence of false positives and risks of overtreatment is good.

Me, I am suspicious when my insurance company wants to give me money. They only pay 15 cents of my $30 prescriptions. And they also offered me a gift card to get screened for mental decline...or whatever that "wellness" thing is all about. My detector is going ooga-ooga!

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