Goodwin Suzanne M, Anderson Gerard F
Johns Hopkins Bloomberg School of Public Health.
Johns Hopkins Bloomberg School of Public Health, Center for Hospital Finance and Management.
Medicare Medicaid Res Rev. 2012 Feb 8;2(1). doi: 10.5600/mmrr.002.01.a03. eCollection 2012.
Section 4104 of the Patient Protection and Affordable Care Act (ACA) waives previous cost-sharing requirements for many Medicare-covered preventive services. In 1997, Congress passed similar legislation waiving the deductible only for mammograms and Pap smears. The purpose of this study is to examine the effect of the deductible waiver on mammogram and Pap smear utilization rates.
Using 1995-2003 Medicare claims from a sample of female, elderly Medicare fee-for-service beneficiaries, two pre/post analyses were conducted comparing mammogram and Pap smear utilization rates before and after implementation of the deductible waiver. Receipt of screening mammograms and Pap smears served as the outcome measures, and two time measures, representing two post-test observation periods, were used to examine the short- and long-term impacts on utilization.
There was a 20 percent short-term and a 25 percent longer term increase in the probability of having had a mammogram in the four years following the 1997 deductible waiver. Beneficiaries were no more likely to receive a Pap smear following the deductible waiver.
Elimination of cost sharing may be an effective strategy for increasing preventive service use, but the impact could depend on the characteristics of the procedure, its cost, and the disease and populations it targets. These historical findings suggest that, with implementation of Section 4104, the greatest increases in utilization will be seen for preventive services that screen for diseases with high incidence or prevalence rates that increase with age, that are expensive, and that are performed on a frequent basis.
《患者保护与平价医疗法案》（ACA）第4104条免除了许多医疗保险涵盖的预防性服务先前的费用分摊要求。1997年，国会通过了类似立法，仅免除乳房X光检查和巴氏涂片检查的免赔额。本研究的目的是检验免赔额豁免对乳房X光检查和巴氏涂片检查利用率的影响。
利用1995 - 2003年来自女性老年医疗保险按服务收费受益人的样本的医疗保险理赔数据，进行了两次前后分析，比较了免赔额豁免实施前后乳房X光检查和巴氏涂片检查的利用率。接受筛查乳房X光检查和巴氏涂片检查作为结果指标，并使用两个时间指标（代表两个测试后观察期）来检验对利用率的短期和长期影响。
1997年免赔额豁免后的四年内，进行乳房X光检查的概率短期增加了20%，长期增加了25%。免赔额豁免后，受益人接受巴氏涂片检查的可能性并未增加。
消除费用分摊可能是增加预防性服务使用的有效策略，但影响可能取决于检查程序的特点、成本以及所针对的疾病和人群。这些历史研究结果表明，随着第4104条的实施，对于筛查发病率或患病率高、随年龄增长、费用昂贵且频繁进行的疾病的预防性服务，利用率将有最大幅度的提高。
