CAPÍTULO 2 CANTOS TRADICIONALES KAKATAIBO
2.1 S OBRE EL CONCEPTO DE TRADICIÓN
treatment, service or equipment, supplies or drugs, as applicable, that is determined to be equally safe and effective by credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community.
As discussed in the Background section, the American Cancer Society, the American College of Radiology,
507 American Cancer Society. 2009. Cancer Facts and Figures 2009. Available at: http://ww3.cancer.org/downloads/STT/500809web.pdf.
Accessed on April 19, 2010.
and the U.S. Multi-Society Task Force on Colorectal Cancer collaborated on colorectal cancer screening guidelines.508 The six recommended screening procedures are categorized into two groups: those that detect cancer, and those that detect pre-cancerous polyps and cancer. Single stool sample FOBT cards and
“toilet bowl tests” are not recommended colorectal cancer screening procedures by the American Cancer Society or any other major medical organization. The benefits, limitations and estimated costs of each of the recommended screening procedures are detailed in Table I.10.2.509 It should be noted that positive results based on any of the screeners should be followed by a colonoscopy for a more detailed evaluation and necessary treatment.
Usually doesn’t require full bowel preparation
Sedation usually not used Does not require a specialist Done every 5 years
Views only about a third of the colon Can miss small polyps
Can’t remove all polyps May be some discomfort
Very small risk of bleeding, infection, or bowel tear
Colonoscopy will be needed if abnormal Colonoscopy
Estimated cost:
$1,000
Can usually view entire colon Can biopsy and remove polyps Done every 10 years
Sedation of some kind is usually needed Will need someone to drive you home You may miss a day of work
Small risk of bleeding, bowel tears, or infection
Double-contrast barium enema (DCBE)
Estimated cost:
$300-400
Can usually view entire colon Relatively safe
Done every 5 years No sedation needed
Can miss small polyps
Full bowel preparation needed Some false positive test results Cannot remove polyps during testing Colonoscopy will be needed if abnormal CT colonography
(virtual colonoscopy)
Estimated cost:
$1,000
Fairly quick and safe
Can usually view entire colon Done every 5 years
No sedation needed
Can miss small polyps
Full bowel preparation needed Some false positive test results Cannot remove polyps during testing Colonoscopy will be needed if abnormal Still fairly new - may be insurance issues
508 Levin B, Lieberman DA, McFarland B, et al. 2008. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008; a joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians 58(3): 130-60.
509 American Cancer Society. 2009. Cancer Facts and Figures 2009. Available at: http://ww3.cancer.org/downloads/STT/500809web.pdf.
Accessed on April 19, 2010.
Table I.10.2 Benefits, limitations and estimated costs of the recommended screening procedures
Test Pros Cons
Fecal occult blood test (FOBT)
Estimated cost:
$30
No direct risk to the colon No bowel preparation
Colonoscopy will be needed if abnormal Fecal immunochemical
test (FIT)
Estimated cost:
$30
No direct risk to the colon No bowel preparation
Colonoscopy will be needed if abnormal
Stool DNA test
Estimated cost:
$350
No direct risk to the colon No bowel preparation Still a fairly new test
Not clear how often it should be done Colonoscopy will be needed if abnormal
7. The impact of insurance coverage for the treatment, service or equipment, supplies or drugs, as applicable, on the total cost of health care, including potential benefits or savings to insurers and employers resulting from prevention or early detection of disease or illness related to such coverage.
The total cost of health care is understood to be the funds flowing into the medical system, which are the medical costs of insurance premiums and cost sharing. Actuarial analysis of claims data received from insurers/MCOs in Connecticut shows an expected cost in 2010 of $61,791,095 for colorectal cancer treatments for Connecticut residents covered by fully-insured group and individual health insurance plans.
Individuals with early stage colorectal cancer typically do not have any noticeable symptoms. Therefore, screening is essential to identify and remove pre-cancerous polyps and to treat early stage colorectal cancer at a more curable point. Screening has contributed in large part to the sizable decrease in incidence and mortality rates for colorectal cancer over the past two decades. Incidence rates have declined from 66.3 cases per 100,000 population in 1985 to 46.4 in 2005.510 Similar results were found for mortality rates.511
8. The impact of the mandated health care benefit on the cost of health care for small employers, as defined in section 38a-564 of the general statutes, and for employers other than small employers.
No published literature was found regarding the effect of mandated coverage for colorectal cancer screening on the cost of health care for small employers. Small employers have a reduced negotiating power due to a smaller number of covered lives in their insurance plans. The relatively high estimated cost of the mandate ($4.08 PMPM in fully insured group plans) suggests potential differences in effects among different sized
510 American Cancer Society. 2009. Cancer Facts and Figures 2009. Available at: http://ww3.cancer.org/downloads/STT/500809web.pdf.
Accessed on April 19, 2010.
511 Ibid.
employers.
For further information regarding the differential effect of the mandates on small group versus large group insurance, please see Appendix II: Ingenix Consulting Actuarial and Economic Report, page 30-31.) 9. The impact of the mandated health benefit on cost-shifting between private and public payers of
health care coverage and on the overall cost of the health care delivery system in the state.
Cost-shifting between private and public payers of health care coverage generally occurs when formerly privately insured persons, after enrolling in a public program or becoming un- or underinsured, require and are provided health care services. Cost-shifting also occurs when a formerly publicly-funded service becomes the responsibility of private payers, which can result following enactment of a health insurance mandate.
Most persons formerly covered under private payers lose such coverage due to a change in employer, change in employment status, or when private payers discontinue offering health care coverage as an employee benefit or require employee contributions to premiums that are not affordable. Because this required benefit became effective in 2001, it is unlikely that the mandate, taken individually, has any impact on cost-shifting between private and public payers of health care coverage at present.
The overall cost of the health delivery system in the state is understood to include total insurance premiums (medical costs and retention) and cost sharing. Actuarial analysis of claims data received from insurers/
MCOs in Connecticut shows an expected cost in 2010 of $72,793,836 for colorectal cancer screening for Connecticut residents covered by fully-insured group and individual health insurance plans.
For further information, please see Appendix II, Ingenix Consulting Actuarial and Economic Report.