Is Patient Cost-Sharing the Best Way to Protect the Medical Commons?
Authors: Robert H. Fletcher, James E. Sabin, Joseph Dorsey
Journal: Annals of Internal Medicine (2008)

Letters16 September 2008Is Patient Cost-Sharing the Best Way to Protect the Medical Commons?Robert H. Fletcher, MD, MSc, James E. Sabin, MD, and Joseph Dorsey, MDRobert H. Fletcher, MD, MScFrom Harvard Medical School, Boston, MA 02115.Search for more papers by this author, James E. Sabin, MDFrom Harvard Medical School, Boston, MA 02115.Search for more papers by this author, and Joseph Dorsey, MDFrom Harvard Medical School, Boston, MA 02115.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-6-200809160-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Wharam and colleagues (1) reported that a high-deductible insurance plan providing first-dollar coverage for fecal occult blood tests (FOBTs) but not colonoscopies did not change colorectal cancer screening rates but did result in somewhat higher use of FOBTs and lower use of colonoscopies. The article and accompanying editorial (2) imply that it might be unsound to cover FOBTs but not colonoscopies. However, clinical practice guidelines at the time of the study recommended both tests. These guidelines did not consider either method to be unequivocally superior, but pointed out that they had different characteristics that might matter to ...References1. Wharam JF, Galbraith AA, Kleinman KP, Soumerai SB, Ross-Degnan D, Landon BE. Cancer screening before and after switching to a high-deductible health plan. Ann Intern Med. 2008;148:647-55. [PMID: 18458277] LinkGoogle Scholar2. Mahajan AP, Brook RH. High-deductible health plans and better benefit design [Editorial]. Ann Intern Med. 2008;148:704-6. [PMID: 18458284] LinkGoogle Scholar3. Sabin JE, Cochran D. Confronting trade-offs in health care: Harvard Pilgrim Health Care's organizational ethics program. Health Aff (Millwood). 2007;26:1129-34. [PMID: 17630456] CrossrefMedlineGoogle Scholar4. Emanuel EJ. The cost-coverage trade-off: “it's health care costs, stupid”. JAMA. 2008;299:947-9. [PMID: 18314437] CrossrefMedlineGoogle Scholar5. Hiatt HH. Protecting the medical commons: who is responsible? N Engl J Med. 1975;293:235-41. [PMID: 1143304] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard Medical School, Boston, MA 02115.Disclaimer: The authors are affiliated with Harvard Pilgrim Health Care, whose policies were studied in the article (1) and commented on in the editorial (2).Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCancer Screening before and after Switching to a High-Deductible Health Plan J. Frank Wharam , Alison A. Galbraith , Ken P. Kleinman , Stephen B. Soumerai , Dennis Ross-Degnan , and Bruce E. Landon High-Deductible Health Plans and Better Benefit Design Anish P. Mahajan and Robert H. Brook Is Patient Cost-Sharing the Best Way to Protect the Medical Commons? Anish P. Mahajan and Robert H. Brook Metrics 16 September 2008Volume 149, Issue 6Page: 435KeywordsCancer preventionColonColonoscopyColorectal cancer screeningConflicts of interestHealth careHealth care policyHealth insuranceHematologic testsTreatment guidelines ePublished: 16 September 2008 Issue Published: 16 September 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...