Cooper Gregory S, Kou Tzuyung Doug, Dor Avi, Koroukian Siran M, Schluchter Mark D
Division of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Cancer. 2017 May 1;123(9):1585-1589. doi: 10.1002/cncr.30476. Epub 2017 Jan 9.
Out-of-pocket expenditures are thought to be an important barrier to the receipt of cancer preventive services, especially for those of a lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. The objective of this study was to determine changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation.
Using Medicare claims data, this study identified women who were 70 years old or older and had not undergone mammography in the previous 2 years and men and women who were 70 years old or older, were at increased risk for colorectal cancer, and had not undergone colonoscopy in the past 5 years. The receipt of procedures in the 2-year period before the ACA's implementation (2009-2010) and after its implementation (2011 to September 2012) was also identified. Multivariate generalized estimating equation models were used to determine the independent association and county-level quartile of median income and education with the receipt of testing.
For mammography, a lower SES quartile was associated with less uptake, but the post-ACA disparities were smaller than those in the pre-ACA period. In addition, mammography rates increased from the pre-ACA period to the post-ACA period in all SES quartiles. For colonoscopy, in both the pre- and post-ACA periods, there was an association between uptake and educational level and, to some extent, income. However, there were no appreciable changes in colonoscopy and SES after implementation of the ACA.
The removal of out-of-pocket expenditures may overcome a barrier to the receipt of recommended preventive services, but for colonoscopy, other procedural factors may remain as deterrents. Cancer 2017;123:1585-1589. © 2017 American Cancer Society.
自付费用被认为是获得癌症预防服务的一个重要障碍，对于社会经济地位较低的人群（SES）而言尤其如此。《平价医疗法案》（ACA）取消了包括乳房X光检查和结肠镜检查在内的推荐服务的自付费用。本研究的目的是确定在ACA实施前后，按服务收费的医疗保险受益人群中乳房X光检查和结肠镜检查的接受率变化。
利用医疗保险理赔数据，本研究确定了年龄在70岁及以上且在过去2年内未接受过乳房X光检查的女性，以及年龄在70岁及以上、患结直肠癌风险增加且在过去5年内未接受过结肠镜检查的男性和女性。同时还确定了ACA实施前（2009 - 2010年）和实施后（2011年至2012年9月）这两个时间段内这些检查的接受情况。使用多变量广义估计方程模型来确定接受检查与收入中位数和教育程度的县级四分位数之间的独立关联。
对于乳房X光检查，较低的SES四分位数与接受率较低相关，但ACA实施后的差距小于实施前。此外，所有SES四分位数的乳房X光检查率从ACA实施前到实施后均有所上升。对于结肠镜检查，在ACA实施前和实施后，接受率与教育水平以及在一定程度上与收入之间均存在关联。然而，ACA实施后结肠镜检查与SES之间没有明显变化。
取消自付费用可能会克服接受推荐预防服务的障碍，但对于结肠镜检查，其他程序因素可能仍然是阻碍因素。《癌症》2017年；123:1585 - 1589。©2017美国癌症协会。
