Each day a colonoscopy is skipped somewhere in the United States, and for good reason. Most individuals indicate the pain, discomfort, and general awkwardness they’ve endured during this LIFE-saving procedure as their reasons to avoid the doctor’s office.
For those who do decide to undergo the procedure, a majority utilize some form of anesthesia or moderate conscious sedation as means for comfort. But what level of comfort? And at what cost? These are questions that health insurance company Highmark, the dominant insurer in western Pennsylvania, deliberated over before announcing they would no longer “pay benefits for monitored anesthesia for average-risk patients receiving endoscopic procedures”. The announcement caused quite an uproar among doctors, patients, and legislators who spoke of the values of colonoscopy, its effectiveness in detecting the nation’s second-deadliest cancer, and the 25,000 lives saved each year, factors they feel outweigh the reported $1.1 billion per year general anesthesia adds in costs (the combined net worth of Jay-Z and Beyoncé).
The decision may seem unthinkable to many but it has happened before. Highmark isn’t the first company to do away with monitored anesthesia. In fact, Aetna considered doing the same in 2008 but rejected the idea after overwhelming public outcry, and weighing the benefits of colonoscopies against the likelihood that patients would forgo the procedure due to discomfort.
The Highmark decision is one based on capital and luxury, involving a procedure Gregory Ginsberg, director of Endoscopic Services at Penn Medicine, refers to as “uncomfortable.” He goes on to say “in most patients, we need some level of sedation to complete the procedure.” With the use of anesthesia “patients have no discomfort or memory of the procedure, and when the procedure is completed and the drip turned off, the patient wakes at once, without grogginess.”
Though the company insists they are sensitive to the needs of their patients they stand by their decision, and instead point toward less invasive methods for colon screening include fecal occult blood samples, flexible sigmoidoscopy, CT colonography, and even the swallowing of a small encapsulated camera that records intermittent photos as it moves through the colon.
We would like to hear your thoughts on the Highland decision. If you have any personal or professional experience with patients avoiding procedures because of discomfort, or with insurer’s efforts to cut costs in controversial ways, leave us a comment.
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