Department of Radiology, University of Michigan, Ann Arbor, Michigan; Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, Michigan.
J Am Coll Radiol. 2019 Jun;16(6):788-796. doi: 10.1016/j.jacr.2019.01.028. Epub 2019 Mar 2.
To assess changes in screening mammography cost sharing and utilization before and after the Affordable Care Act (ACA) and the revised US Preventive Services Task Force (USPSTF) guidelines. To compare mammography cost sharing between women aged 40 to 49 and those 50 to 74.
We used patient-level analytic files between 2004 and 2014 from Clinformatics Data Mart (OptumInsight, Eden Prairie, Minnesota). We included women 40 to 74 years without a history of breast cancer or mastectomy. We conducted an interrupted time series analyses assessing cost sharing and utilization trends before and after the ACA implementation and USPSTF revised guidelines.
We identified 1,763,959 commercially insured women aged 40 to 74 years. Between 2004 and 2014, the proportion of women with zero cost share for screening mammography increased from 81.9% in 2004 to 98.2% in 2014, reaching 93.1% with the 2010 ACA implementation. The adjusted median cost share remained $0 over time. Initially at 36.0% in 2004, screening utilization peaked at 42.2% in 2009 with the USPSTF guidelines change, dropping to 40.0% in 2014. Comparing women aged 40 to 49, 50 to 64, and 65 to 74, the proportion exposed to cost sharing declined over time in all groups.
A substantial majority of commercially insured women had first-dollar coverage for mammography before the ACA. After ACA, nearly all women had access to zero cost-share mammography. The lack of an increase in mammography use post-ACA can be partially attributed to a USPSTF guideline change, the high proportion of women without cost sharing before the ACA, and the relatively low levels of cost sharing before the policy implementation.
评估《平价医疗法案》（ACA）和美国预防服务工作组（USPSTF）修订指南前后筛查性乳房 X 光检查成本分担和利用情况的变化。比较 40 至 49 岁和 50 至 74 岁女性的乳房 X 光检查成本分担情况。
我们使用了 2004 年至 2014 年期间来自 Clinformatics Data Mart（OptumInsight，Eden Prairie，明尼苏达州）的患者水平分析文件。我们纳入了 40 至 74 岁且无乳腺癌或乳房切除术病史的女性。我们进行了一项中断时间序列分析，以评估 ACA 实施和 USPSTF 修订指南前后的成本分担和利用趋势。
我们确定了 1763959 名 40 至 74 岁的商业保险女性。2004 年至 2014 年间，零成本分担接受筛查性乳房 X 光检查的女性比例从 2004 年的 81.9%增加到 2014 年的 98.2%，随着 2010 年 ACA 的实施，该比例达到了 93.1%。调整后的中位数成本分担额保持为 0。最初在 2004 年为 36.0%，USPSTF 指南变更后，2009 年筛查利用率达到峰值 42.2%，2014 年降至 40.0%。比较 40 至 49 岁、50 至 64 岁和 65 至 74 岁的女性，随着时间的推移，所有组中暴露于成本分担的女性比例都有所下降。
在 ACA 之前，绝大多数商业保险女性都有医疗保险来支付乳房 X 光检查的费用。在 ACA 之后，几乎所有女性都可以享受零成本分担的乳房 X 光检查。ACA 后乳房 X 光检查使用率没有增加，部分原因是 USPSTF 指南的变化，ACA 之前女性中没有成本分担的比例较高，以及政策实施前成本分担水平相对较低。
