Commercially insured women less likely to be referred for interventional procedures
The type of insurance coverage women carry has a significant impact on how providers opt to treat their uterine fibroids, new data reveal.
As many as 80% of women will develop uterine fibroids during their lifetime, up to half of whom may seek treatment for the condition, which can be painful and affect aspects of everyday living. The most common treatment options are surgery, either via open or closed hysterectomy or myomectomy, but these are costly, require prolonged downtime and are accompanied by the inherent risks of surgery
Another option is uterine artery embolization (UAE)—an interventional radiology procedure known to be just as effective as other fibroid treatments, but less painful and less invasive. UAE also spares women from having their uterus removed, which is considered a big benefit depending on age.
Despite the known benefits of UAE, the procedure is vastly underutilized. A recent survey conducted by the Society of Interventional Radiology (SIR) found that just 17% of women with fibroids are consulted about the prospect of UAE. Responses to that survey indicated a general lack of knowledge about the procedure was a driving factor in its underutilization.
However, new evidence published in the Journal of the American College of Radiology suggests that insurance coverage and the resultant reimbursements also may hinder its use.
“Economic incentives may also influence gynecologists’ treat-or-refer decision. For example, it has been demonstrated that referrals to interventional radiology for UAE are disproportionately growing for the underinsured patients,” Eric W. Christensen, PhD, Research Director at Neiman Health Policy Institute, and colleagues explained. “This is surprising as we would not expect, given economic incentives, that more disadvantaged patients would receive the less invasive treatment; however, the unique nature of the treat-or-refer decision, may result in response to economic incentives that are not obvious on the surface.”
To get a better idea of how insurance type influences referrals, researchers conducted a retrospective study of women ages 30-59 years who underwent treatment for fibroids from October 2015 to September 2023, resulting in more than 500,000 cases. The team compared procedure type alongside insurance coverage and reimbursement rates, controlling for patient characteristics and geographic differences.
The group found that individuals covered by Medicaid insurance were 38% more likely to undergo UAE compared to those who carried commercial insurance. However, in contrast, states with higher Medicaid reimbursement for hysterectomy and myomectomy had lower rates of the interventional procedure. Medicaid coverage was also found to be associated with open, rather than laparoscopic, hysterectomy and myomectomy.
“Reimbursement may influence this treat-or-refer decision,” the authors proposed. “Note that unless patients are personally aware of UAE as a treatment option, they would need to be informed about it by their gynecologist or be referred to an interventional radiologist for a consultation. For the patients gynecologists choose to treat by hysterectomy or myomectomy, reimbursement may influence the type of treatment (i.e., open or laparoscopic) they provide.”
The study’s results suggest gynecologists are more likely to refer patients with insurance that yields lower reimbursements out for treatment, while commercially insured women are more often treated surgically in house.
“These findings raise the question of whether insurance reimbursement impacts referral patterns for other conditions and specialties, and the extent to which it may outweigh evidence-based care decisions,” the group wrote.
Regardless of insurance coverage, patients should be made aware of all the available treatment options, the authors suggested. This is especially relevant in the setting of women’s health and uterine fibroids, as many women who have undergone hysterectomy or myomectomy have reported feeling underinformed about their treatment options.
Learn more about the team’s findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.