NCPA - National Center for Policy Analysis

A WAY TO ENCOURAGE COLONOSCOPIES

January 10, 2006

Propofol is an increasingly popular anesthetic used during colonoscopies to make the procedure more comfortable. Patients like it. Doctors like it. But because it often requires the presence of an anesthesiologist, some insurance companies don't want to pay for it, says the Tampa Bay Tribune.

Propofol sedates patients quickly and lets them awaken more swiftly than other methods of sedation. But according to the Wall Street Journal, an anesthesiologist adds $250 to $400 to the cost of a colonoscopy. That's why WellPoint Inc., the country's biggest health insurer, has changed its guidelines to say an anesthesiologist's presence is not medically necessary during the procedure. Others are considering the same thing.

This is a mistake on two fronts, says the Tribune:

  • Many doctors believe the availability of propofol helps convince squeamish patients to get a colonoscopy, and if cancer is found, the insurance company would save money in the long run.
  • Perhaps more importantly, propofol has risks, among them falling blood pressure, loss of airway reflexes and breathing problems; anesthesiologists minimize those risks.

A recent Florida Board of Medicine report shows there were 38 endoscopy-related deaths in Florida among outpatients between 2000 and 2004. "It is shortsighted of an insurance company to try to save less than $100 on a procedure then spend tens of thousands of dollars on the complications that can occur following anesthetic mishap," says Hector Vila, anesthesiology division chief at H. Lee Moffitt Cancer Center.

Another study, however, reported that in 36,743 cases in which registered nurses administered propofol, there were no significant mishaps.

Insurance companies should encourage the use of advanced drugs like propofol, delivered by qualified specialists, says the Tribune.

Source: Editorial, "A Way To Encourage Colonoscopies," January 9, 2006.

 

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