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New York Insurers Will Continue to Cover Prostate Cancer Screenings - - Because They Have To

Earlier this month, the US Preventive Service Task Force released an "Evidence Update" on a certain kind of prostate cancer screening with the following conclusion: "Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary."

The announcement touched off a predictable howl, with the New York Times citing opposition from pretty much everyone, from drug makers and doctors to patient advocacy groups to Joe Torre and Rudy Giuliani, both prostate cancer survivors.

More recently, Buffalo Business First surveyed Western New York health insurers and reported that they plan to continue covering the costs of prostate cancer screenings. Most of the article focused on informed decision-making and the various positions of outfits such as the Prostate Cancer Foundation and the American Urological Association.

As if. Barely mentioned in the Business First article and not at all in the New York Times article is New York's prostate cancer screening mandate. Residing in Section 4303(z-1) of the Insurance Law (among other places), the mandate requires health insurers to cover the PSA test for: (1) any man at any age with a history of prostate cancer; (2) any asymptomatic man 50 or over; and (3) any man 40 or over with a family history of prostate cancer.

The downside of widespread screening is significant, at both a personal and societal level. The New york Times summarizes:

As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both.

It is these findings that led Richard J. Ablin, who discovered a prostate-specific antigen in 1970, to refer to the effects of widespread PSA screening as a "public health disaster."

The example of prostate cancer screening illustrates the folly of insurance mandates. In no small part it renders any debate over the medical efficacy of such tools as moot: whether or not PSA testing is a wise use of limited enrollee premium dollars is not a discussion that health insurers can even engage in. They are required to provide the coverage. As long as insurance covers PSA screening, patients will continue to demand it, and providers will continue to prescribe it. And who will offer legislation to peel back screening coverage in the face of so much popular opposition?

Perverse as it seems, New York law requires insurance coverage of a service that the national Preventive Services Task Force has found ineffective and the widespread use of which has been described as a public health disaster--an unintended but very real consequence.

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This page contains a single entry from the blog posted on October 14, 2011 10:50 AM.

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