Steenland Maria, Sinaiko Anna, Glynn Amy, Fitzgerald Therese, Cohen Jessica
Population Studies and Training Center, Brown University, 68 Waterman St, Providence, RI 02912, USA.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
Prev Med Rep. 2019 Jun 21;15:100924. doi: 10.1016/j.pmedr.2019.100924. eCollection 2019 Sep.
In an effort to increase use of preventive health care, The Patient Protection and Affordable Care Act (ACA) eliminated cost-sharing for preventive cancer screening services for the privately insured. The impact on patient spending and use of these screenings is still poorly understood. We used an interrupted time series analysis with the Massachusetts All-Payer Claims Database (2009-2012) to assess changes in trends in costs and use of breast, cervical and colorectal cancer screenings after the ACA policy. We find that the ACA was associated with a 0.024 (95% CI: -0.031, -0.017, p < 0.001) and 0.424 (95% CI: -0.481, -0.368, p < 0.001) percentage point decrease in the likelihood of a copayment each week for preventive breast and cervical cancer screenings respectively. The likelihood of copayment for colon cancer screening declined throughout the study period, with the rate of decline slowing following the ACA (trend in percent of screenings with copayment -0.130 before vs -0.071 after ACA, p = 0.014). Overall, we find only weak evidence that the ACA policy increased screenings. We find no significant effect on utilization for cervical cancer or colon cancer screening. For breast cancer screening, we find a small immediate increase in the utilization rate in the month after the policy change, with no change in trend after the ACA policy. Policy makers may need to consider other complementary policy options to increase screening rates.
为了增加预防性医疗保健的使用，《患者保护与平价医疗法案》（ACA）取消了为参加私人保险者提供的预防性癌症筛查服务的费用分摊。该法案对患者在这些筛查方面的支出和使用情况的影响仍知之甚少。我们使用马萨诸塞州全支付者索赔数据库（2009 - 2012年）进行中断时间序列分析，以评估ACA政策实施后乳腺癌、宫颈癌和结直肠癌筛查的成本和使用趋势的变化。我们发现，ACA与预防性乳腺癌和宫颈癌筛查每周的自付费用可能性分别降低0.024个百分点（95%置信区间：-0.031，-0.017，p < 0.001）和0.424个百分点（95%置信区间：-0.481，-0.368，p < 0.001）相关。在整个研究期间，结肠癌筛查的自付费用可能性下降，ACA实施后下降速度放缓（有自付费用的筛查百分比趋势：ACA实施前为-0.130，实施后为-0.071，p = 0.014）。总体而言，我们仅发现微弱证据表明ACA政策增加了筛查。我们发现对宫颈癌或结肠癌筛查的利用率没有显著影响。对于乳腺癌筛查，我们发现政策改变后的当月利用率立即有小幅上升，ACA政策实施后趋势没有变化。政策制定者可能需要考虑其他补充性政策选项以提高筛查率。
