Toseef Mohammad Usama, Jensen Gail A, Tarraf Wassim
Institute of Gerontology, Wayne State University, 87 East Ferry Street, Detroit, MI 48202, USA; Department of Economics, Wayne State University, Faculty/Administration Bldg, 656 W. Kirby St 2074, FAB, Detroit, MI 48202, USA.
Institute of Gerontology, Wayne State University, 87 East Ferry Street, Detroit, MI 48202, USA; Department of Healthcare Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA.
Prev Med. 2020 Sep;138:106148. doi: 10.1016/j.ypmed.2020.106148. Epub 2020 May 27.
Since 2011, the Affordable Care Act (ACA) requires the provision of certain recommended clinical preventive services without cost-sharing for individuals in Medicare. We re-visited the effects of the ACA on preventive services utilization under Medicare, using data from the Medical Expenditure Panel Survey (MEPS) and examined the ACA's longer-term effects on preventive services utilization among Medicare beneficiaries. We analyzed nationally representative data on non-institutionalized Medicare beneficiaries (n = 27,124) from the 2006-2010 and 2012-2016 Medical Expenditure Panel Survey. Preventive services of interest were cholesterol test, blood pressure test, flu shot, endoscopy, blood stool test, clinical breast exam, mammography and prostate exam. We estimated propensity score weighted difference-in-difference (DID) models to test for differences in preventive services utilization based on Medicare insurance status. Nationwide, among beneficiaries with traditional Medicare only, who stood to gain the most from eliminating cost-sharing for preventive services, the percentage of women receiving clinical breast exams rose post-reform (Δ = 8.1%; p < 0.015) as compared to Medicare beneficiaries with supplemental private coverage, while at the same time the percentage receiving other preventive services did not change post-reform (all p > 0.05). Based on this analysis of MEPS data spanning 2006-2016, the ACA's enhancement of Medicare coverage had only modest effects on the percentage of beneficiaries receiving a range of preventive services. Medicare beneficiaries should be better informed of the availability of these services and encouraged by their physicians to avail the no cost-sharing incentive of these reforms.
自2011年起，《平价医疗法案》（ACA）要求为参加医疗保险的个人提供某些推荐的临床预防服务，且无需分担费用。我们利用医疗支出面板调查（MEPS）的数据，重新审视了ACA对医疗保险下预防服务利用情况的影响，并研究了ACA对医疗保险受益人预防服务利用的长期影响。我们分析了2006 - 2010年和2012 - 2016年医疗支出面板调查中具有全国代表性的非机构化医疗保险受益人的数据（n = 27,124）。感兴趣的预防服务包括胆固醇检测、血压检测、流感疫苗接种、内窥镜检查、大便潜血检测、临床乳房检查、乳房X光检查和前列腺检查。我们估计了倾向得分加权差异-in-差异（DID）模型，以检验基于医疗保险状况的预防服务利用差异。在全国范围内，仅参加传统医疗保险的受益人中，那些从消除预防服务费用分担中获益最多的人，与拥有补充私人保险的医疗保险受益人相比，改革后接受临床乳房检查的女性比例有所上升（Δ = 8.1%；p < 0.015），而与此同时，接受其他预防服务的比例在改革后没有变化（所有p > 0.05）。基于对2006 - 2016年MEPS数据的分析，ACA对医疗保险覆盖范围的扩大对接受一系列预防服务的受益人的比例影响不大。医疗保险受益人应该更好地了解这些服务的可用性，并受到医生的鼓励，利用这些改革的无费用分担激励措施。
