Anish P. Mahajan, MD, MPH; Robert H. Brook, MD, ScD
Disclaimer: Dr. Brook's wife, Dr. Jacqueline Kosecoff, is CEO of Prescription Solutions.
Potential Financial Conflicts of Interest: None disclosed.
Mahajan AP, Brook RH. Is Patient Cost-Sharing the Best Way to Protect the Medical Commons?. Ann Intern Med. 2008;149:435-436. doi: 10.7326/0003-4819-149-6-200809160-00016
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Published: Ann Intern Med. 2008;149(6):435-436.
We thank Dr. Fletcher and colleagues for their thoughtful letter describing HPHC's decision-making process and rationale for providing first-dollar coverage of FOBT, but not colonoscopy, in its high-deductible health plan. The HPHC's ethics advisory group, which engages a range of stakeholders, is laudable.
Dr. Fletcher and colleagues defend HPHC's decision to provide first-dollar coverage for FOBT but not colonoscopy by citing evidence-based guidelines, from the time when the coverage decision was made, that regarded the 2 screening interventions as equally effective. In light of new consensus guidelines recommending colonoscopy over FOBT because of the added benefit of early detection and removal of polyps (1), we reviewed the high-deductible health plan information available to potential enrollees on HPHC's Web site and found that colonoscopy is still subject to the deductible (2). Given the plan's goal to design benefits in a way that encourages the use of high-value preventive services, we hope that the HPHC is in the process of changing its high-deductible health plan policy to provide first-dollar coverage for colonoscopy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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