Health plan policies and programs for colorectal cancer screening: a national profile

Am J Manag Care. 2004 Apr;10(4):273-9.


Background: A consensus has emerged that average-risk adults 50 years of age or older should be screened for colorectal cancer (CRC).

Objectives: To describe health plans' coverage policies, guidelines, and organized programs to promote CRC screening.

Study design and methods: Review of data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices, administered to a national sample of health plans in 1999-2000. The survey inquired about coverage policies for fecal occult blood testing, sigmoidoscopy, colonoscopy, and double-contrast barium enema; the nature of any guidelines the plan had issued to its providers on CRC screening; and systems for recruiting patients into screening and for tracking and reporting the results of screening and follow-up procedures.

Results: Of 346 eligible health plans, 180 (52%) responded. Nearly all health plans covered at least 1 CRC screening modality. Plans were most likely to cover fecal occult blood testing (97%) and least likely to cover colonoscopy (57%). Sixty-five percent had issued guidelines on CRC screening to providers. One quarter had a mechanism to remind patients that they are due for CRC screening, but fewer had systems for prompting providers, contacting noncompliant patients, or tracking completion of screening.

Conclusions: Health plans have the ability to provide organizational infrastructure for a broad range of preventive services to well-defined populations. However, few health plans had all 3 essential CRC screening delivery components--coverage, guidelines, and tracking systems--in place in 1999-2000.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accreditation
  • Capitation Fee
  • Chi-Square Distribution
  • Colorectal Neoplasms / diagnosis*
  • Guideline Adherence / standards
  • Guideline Adherence / statistics & numerical data
  • Health Care Surveys
  • Humans
  • Insurance Coverage / organization & administration*
  • Insurance, Health* / statistics & numerical data
  • Mass Screening / organization & administration*
  • Medicaid
  • Medicare
  • Models, Organizational
  • Organizational Policy
  • Ownership
  • Practice Guidelines as Topic
  • Preventive Health Services / organization & administration*
  • Primary Health Care / organization & administration
  • United States