Bhandari Naleen Raj, Li Chenghui
Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Healthcare (Basel). 2019 Mar 1;7(1):36. doi: 10.3390/healthcare7010036.
Currently available evidence regarding the association of the Affordable Care Act's (ACA) elimination of cost-sharing and the utilization of cancer screenings is mixed. We determined whether the ACA's zero cost-sharing policy affected the guideline-concordant utilization of cancer screenings, comparing adults (≥21 years) from 2009 with 2011⁻2014 data from the Medical Expenditure Panel Survey. Study participants were categorized as: 21⁻64 years with any private insurance, ≥65 years with Medicare only, and 21⁻64 years uninsured, with a separate sample for each type of screening test. Adjusted weighted prevalence and prevalence ratios (PR (95%CI)) were estimated. In 2014 (vs. 2009), privately-insured women reported 2% (0.98 (0.97⁻0.99)) and 4% (0.96 (0.93⁻0.99)) reduction in use of Pap tests and mammography, respectively. Privately-insured non-Hispanic Asian women had 16% (0.84 (0.74⁻0.97)) reduction in mammography in 2014 (vs. 2009). In 2011 (vs. 2009), privately-insured and Medicare-only men reported 9% (1.09 (1.03⁻1.16)) and 13% (1.13 (1.02⁻1.25)) increases in colorectal cancer (CRC) screenings, respectively. Privately-insured women reported a 6⁻7% rise in 2013⁻2014 (vs. 2009), and Hispanic Medicare beneficiaries also reported 40⁻44%, a significant rise in 2011⁻2014 (vs. 2009), in the utilization of CRC screenings. While the guideline-concordant utilization of Pap tests and mammography declined in the post-ACA period, the elimination of cost-sharing appeared to have positively affected CRC screenings of privately-insured males, females, and Hispanic Medicare-only beneficiaries. Greater awareness about the zero cost-sharing policy may help in increasing the uptake of cancer screenings.
目前关于《平价医疗法案》（ACA）取消费用分摊与癌症筛查利用率之间关联的现有证据并不一致。我们通过比较2009年的成年人（≥21岁）与医疗支出面板调查2011 - 2014年的数据，来确定ACA的零费用分摊政策是否影响了符合指南的癌症筛查利用率。研究参与者被分为：有任何私人保险的21 - 64岁人群、仅参加医疗保险的≥65岁人群以及21 - 64岁未参保人群，每种筛查测试都有单独的样本。估计了调整后的加权患病率和患病率比值（PR(95%CI)）。2014年（与2009年相比），有私人保险的女性报告巴氏试验和乳房X线摄影的使用率分别降低了2%（0.98(0.97 - 0.99)）和4%（0.96(0.93 - 0.99)）。有私人保险的非西班牙裔亚洲女性在2014年（与2009年相比）乳房X线摄影使用率降低了16%（0.84(0.74 - 0.97)）。2011年（与2009年相比），有私人保险和仅参加医疗保险的男性报告结直肠癌（CRC）筛查分别增加了9%（1.09(1.03 - 1.16)）和13%（1.13(1.02 - 1.25)）。有私人保险的女性在2013 - 2014年（与2009年相比）报告增加了6 - 7%，西班牙裔医疗保险受益人在2011 - 2014年（与2009年相比）也报告CRC筛查利用率显著增加了40 - 44%。虽然在ACA实施后，巴氏试验和乳房X线摄影符合指南的利用率有所下降，但取消费用分摊似乎对有私人保险的男性、女性以及仅参加医疗保险的西班牙裔受益人的CRC筛查产生了积极影响。对零费用分摊政策的更多了解可能有助于提高癌症筛查的接受率。
