Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa

Adonis, Leegale, Basu, Debashis and Luiz, John (2014) Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa. Global Health Action, 7 (1). ISSN 1654-9716

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Abstract

Background: Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and
cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for
chronic diseases of lifestyle (CDL), cancers, and HIV in a health-insured population in South Africa, some of
whom voluntarily opt into a wellness program that incentivizes screening.

Method: A cross-sectional study for the period 2007-2011 was conducted using a random sample of 170,471
health insurance members from a single insurer. Adherence to screening guidelines was calculated from
medical claims data.

Results: Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol
screening. Members of the wellness program were up to three times more likely to screen for diseases (odds
ratio [OR]=3.2 for HIV screening, confidence interval [CI]=2.753.73). Plan type (full comprehensive plan)
was most strongly associated with cholesterol screening (OR=3.53, CI=3.273.80), and most negatively
associated (hospital-only core plan) with cervical cancer screening (OR=0.44, CI=0.280.70). Gender was a
negative predictor for glucose screening (OR=0.88, CI=0.820.96). Provincial residence was most strongly
associated with cervical cancer screening (OR=1.89, CI=0.655.54).
Conclusion: Adherence to screening recommendations was <50%. Plan type, gender, provincial residence,
and belonging to an incentivized wellness program were associated with disproportionate utilization of
screening services, even with equal payment access.

Item Type: Article
Keywords: Screening, Chronic diseases of lifestyle, Cancer, HIV, Health insurance, Incentives
Schools and Departments: School of Business, Management and Economics > Business and Management
Depositing User: Stacey Goldup
Date Deposited: 06 Jun 2017 12:05
Last Modified: 06 Jun 2017 12:13
URI: http://sro.sussex.ac.uk/id/eprint/68370

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