Colonoscopy Outcome

Colonoscopy Outcome

The actual colonoscopy at the Digestive Health Clinic was far less unpleasant than the day beforehand spent taking laxatives to empty out my GI tract. Dr. Schutz came in, explained that they would look for polyps, and because it impossible to tell at this stage if they will become cancerous or not, they would remove any that they found. He also said that while not all colon cancer starts as a polyp, so much of it does that the current screening strategy is reducing color cancer deaths each year. This May 27, 2009 CNN report mentions the dramatic reduction in U.S. cancer death rates 1990-2005.

[T]he cancer death rate among men dropped by 19.2 percent, mainly due to decreases in lung, prostate, and colon cancer deaths. In women, the cancer death rate fell by 11.4 percent, largely due to a drop in breast and colorectal cancer deaths.

This American Cancer Society report indicates that a widening racial gap is developing, with white colorectal cancer incidence and death rates falling much more rapidly than for blacks. Curiously, while the report suggests that being uninsured (or being on Medicaid) is the cause of blacks being less likely to be screened for colon cancer, I find myself wondering if this is really the primary factor.

Blacks with private insurance are, like whites, making more progress in reducing colon cancer rates. I presume that Medicaid provides for colon cancer screening. This suggests that it isn't the lack of insurance that is the problem, but the same present orientation that causes people to not bother getting private health insurance is also causing them to not be screened. This May 1, 2007 New York Times article points out that patient squeamish probably plays the major part in why more than half of those who should be screened--are not.

Nonetheless, I do agree that if lack of health insurance is playing a part in discouraging screening tests, all the more reason to find ways to get as many people insured as we can. I don't know what the total bill on this will turn out to be, but it has to be dramatically cheaper than waiting until it turns into colon cancer.

Enough with public policy; back to my experience. They put in a IV, put some Versed and something else. I spent a minute or two discussing how it wasn't making me sleepy. The next thing I remember, I was waking up.

The doctor told me that they found one very small polyp, which they removed. I should plan on another exam in five years. I'll scan in the pictures later, and add them to the blog.

UPDATE: The wife vetoed putting up the colonoscopy pictures.

However: another reader suggested that Medicaid reimbursement may be so low that doctors may be reluctant to suggest it--he recently had a less certain blood in the feces test, because his deductible is so high. And indeed, I found indications that at least as of a few years ago, Medicaid reimbursement was so low that I am quite it would be out of the reach of most Medicaid recipients. This letter from the May 23, 2002 New England Journal of Medicine is mostly behind a $$$ firewall, but even the opening is pretty suggestive:

To the Editor: Ransohoff and Sandler (Jan. 3 issue)1 underestimate the cost of colonoscopy. Medicare reimbursement to the physician may average $380, but the total cost is much higher if reimbursement to health care professionals and the hospital are considered. In my small community, Medicare reimburses physicians $172 for screening colonoscopy, and the hospital receives $395 for procedural costs.

I don't what this procedure cost my insurer, but considering that I had a half hour of a specialist's time, a nurse, and an IV--I'm guessing that this was well over a thousand dollars. This abstract indicates that Medicare started reimbursing for colonoscopies for average risk patients in 2001--but Medicare isn't Medicaid.

This chart shows Medicaid reimbursement schedule by state for 2004/5, which I am guessing is just the reimbursement to the doctor. I'll be curious to see what the total bill submitted to my insurer is.

UPDATE 2: This site indicates the cost of a colonoscopy in Minnesota is $1568--quite a bit more than Medicaid pays, it appears.