Are Insurance Copayments Unethical?

Opinion.jpgMammograms are recommended for all women over the age of 45 as a breast cancer screening tool. Some insurance and Medicare plans provide full coverage for these tests because they are deemed necessary and beneficial. Other plans apply co-pays to mammograms, and other similar medical interventions, despite the prevalent medical opinion that they are both necessary and beneficial to the health of the patient.

A large-scale study published in the New England Journal of Medicine found that patients who are required to pay $10 or more for a mammogram are significantly less likely to have the examination on a biannual basis when compared to individuals whose insurance plans provided complete coverage. This discrepancy was highest among lower income and less educated individuals, but was present across the board, including educated and financially stable patients.

Many writers and reporters have commented that co-payments for such important medical studies as mammograms are unethical, because they deter patients from having the exam regularly. I have no problem with providing free mammograms for women who legitimately cannot afford their co-pay. However, if someone who has the financial capability to pay $10 for a mammogram chooses not to do so, it is not the fault of the insurance company or the healthcare system, but of the patient.

Patients are responsible for eating healthy, exercising, getting enough sleep, and a myriad of other factors that doctors and insurers cannot control. They are also responsible for having good judgment. If you can afford the co-payment, but you just don’t like it, that is no excuse for failing to access medical care.

Healthcare providers bear the very important responsibility of educating patients about the importance of preventive measures such as annual mammography. Insurers have the task of making healthcare affordable and accessible. No one is responsible for making it free.


Trivedi, A.N., Rakowski, W., Ayanian, J.Z. (2008). Effect of Cost Sharing on Screening Mammography in Medicare Health Plans. New England Journal of Medicine, 358(4), 375-383. DOI: 10.1056/NEJMsa070929

Lindsey Kay, MD

Lindsey Kay, MD, is a medical doctor with training in pathology, and an avid writer. During his training, he worked on pre-clinical and clinical trials in a variety of laboratories related to alcohol effects on the brain, cancer diagnosis, and alternative medicine.
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