Department of Health Policy and Management, University of Pittsburgh, 130 De Soto St, A613, Pittsburgh, PA 15261. Email:
Am J Manag Care. 2020 Feb;26(2):69-74. doi: 10.37765/ajmc.2020.42395.
This study investigated the relationship between state Medicaid co-payment policies and cancer screening for Medicaid-enrolled women.
Cross-sectional analysis of administrative claims and enrollment data.
Our data included Medicaid Analytic eXtract (MAX) outpatient claims files across 43 states in 2003, 2008, and 2010, the years for which both MAX data and state cost-sharing data were available. Data on enrollee demographics and screening services from enrollment and claims files were merged with state-year data on co-payment policies and county-level controls from the Area Health Resources File. Participants were nonelderly, nondisabled, nonpregnant women in the recommended age range for each screening service (50-64 years for mammograms; 21-64 years for Pap tests) enrolled in fee-for-service Medicaid. The main independent variable is whether an enrollee faced cost sharing for preventive services. We examined 3 categories of cost sharing: co-payments for all visits, including for preventive services; co-payments for outpatient visits but waived for preventive services; and no co-payments. The main outcome measure was receipt of mammogram or Pap test within a 12-month period.
Medicaid enrollees with co-payments for preventive services were less likely to receive both screening mammograms and Pap tests than enrollees in states not requiring cost sharing for preventive services.
Co-payments for preventive services discourage breast and cervical cancer screening among Medicaid enrollees. The effect is larger for breast cancer screening, which is costlier and requires an additional visit. Considering this evidence, cost sharing for preventive services may lead to adverse health consequences and greater long-term costs.
本研究调查了州医疗补助共付政策与医疗补助参保妇女癌症筛查之间的关系。
对行政索赔和登记数据进行横断面分析。
我们的数据包括 2003 年、2008 年和 2010 年 43 个州的医疗补助分析提取（MAX）门诊索赔文件，这三年均提供了 MAX 数据和州共付数据。从登记和索赔文件中获取参保人人口统计和筛查服务数据，并与来自区域卫生资源文件的州-年共付政策和县一级控制数据合并。参与者是非老年、非残疾、非怀孕的符合每个筛查服务推荐年龄范围的妇女（50-64 岁接受乳房 X 光检查；21-64 岁接受巴氏试验），参加按服务收费的医疗补助。主要的独立变量是参保人是否需要为预防服务支付费用。我们考察了 3 种共付类型：所有就诊的共付，包括预防服务；仅为门诊就诊支付共付，但为预防服务豁免；以及不支付共付。主要的结果测量是在 12 个月内接受乳房 X 光检查或巴氏试验。
与不要求为预防服务支付费用的州相比，需要为预防服务支付共付的医疗补助参保人接受乳房 X 光检查和巴氏试验的可能性较低。
预防服务的共付费用阻碍了医疗补助参保人的乳腺癌和宫颈癌筛查。对于成本更高且需要额外就诊的乳腺癌筛查，其效果更大。考虑到这一证据，预防服务的共付可能会导致不良健康后果和更高的长期成本。
