Association between colorectal cancer testing and insurance type: Evidence from the Swiss Health Interview Survey 2012

Braun, Alexander Leonhard; Kässner, Anja; Syrogiannouli, Lamprini; Selby, Kevin; Bulliard, Jean-Luc; Martin, Yonas; Guessous, Idris; Tal, Kali; Del Giovane, Cinzia; Zwahlen, Marcel; Auer, Reto (2020). Association between colorectal cancer testing and insurance type: Evidence from the Swiss Health Interview Survey 2012. Preventive Medicine Reports, 19, p. 101111. Elsevier 10.1016/j.pmedr.2020.101111

Braun, Prev Med REp 2020.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (624kB) | Preview

Both colonoscopy and fecal occult blood test (FOBT) are commonly used for colorectal cancer (CRC) screening, but colonoscopy costs much more than FOBT. Swiss insurance offers high or low deductibles and choice of basic or private insurance. We hypothesized that high deductibles and basic insurance discourage colonoscopy, but do not change FOBT rates. We determined the proportion of patients tested for CRC in Switzerland (colonoscopy within 10 years, FOBT within 2 years), and determined associations with health insurance type. We extracted data on 50–75-year-olds from the Swiss Health Interview Surveys of 2012 to determine colonoscopy and FOBT testing rates (n = 7335). Multivariate logistic regression models estimated prevalence ratios (PRs) of CRC testing associated with health insurance type (deductible and private insurance), adjusted for sociodemographic factors (age, gender, education, income) and self-rated health. The weighted proportion of individuals tested for CRC within recommended intervals was 39.5%. Testing with colonoscopy was significantly associated with private insurance (PR 1.85, 95% CI: 1.46–2.35) and low deductible (PR 2.00, 95% CI: 1.56–2.57). Testing with FOBT was significantly associated with deductible (PR 1.71, 95%CI:1.09–2.68) but not with private insurance. About 60% of the Swiss population was not current with CRC testing. After adjusting for covariates, private insurance and low deductible was significantly associated with higher prevalence of CRC testing, indicating that waiving the deductible could increase CRC screening uptake and reduce health inequality.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Braun, Alexander Leonhard, Syrogiannouli, Lamprini, Martin, Yonas Arrefaine, Tal, Kali, Del Giovane, Cinzia, Zwahlen, Marcel, Auer, Reto


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services








Tobias Tritschler

Date Deposited:

19 May 2020 19:23

Last Modified:

05 Dec 2022 15:38

Publisher DOI:


PubMed ID:





Actions (login required)

Edit item Edit item
Provide Feedback