Modell Stephen M, Allen Caitlin G, Ponte Amy, Marcus Gail
Epidemiology, University of Michigan School of Public Health, M5409 SPH II, 1415 Washington Hts., Ann Arbor, MI, 48109, United States.
Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, United States.
J Cancer Policy. 2021 Jun;28:100275. doi: 10.1016/j.jcpo.2021.100275. Epub 2021 Feb 16.
The Affordable Care Act and subsequent reforms pose tradeoffs for racial-ethnic, rural, and sex-related groups in the United States experiencing disparities in BRCA1/2 genetic counseling and testing and colorectal cancer screening, calling for policy changes.
A working group of the American Public Health Association Genomics Forum Policy Committee engaged in monthly meetings to examine ongoing literature and identify policy alternatives in the coverage of cancer genetic services for marginalized groups. 589 items were collected; 408 examined. Efforts continued from February 2015 through September 2020.
African Americans and Latinos have shown 7-8 % drops in uninsured rates since the Exchanges opened. The ACA has increased BRCA1/2 test availability while several disparities remain, including by sex. Rural testing and screening utilization rates have improved. Medicaid expansion and the inclusion of Medicare in the ACA have resulted in mixed improvements in colorectal cancer screening rates in marginalized groups.
Cancer genetic testing and screening to date have only partially benefited from healthcare reforms. Sensitivity to cost concerns and further monitoring of emerging data are needed. A reduction in disparities depends on the availability of private insurance, Medicaid and Medicare to the marginalized. Attention to value-based design and the way cancer benefits are translated into actual testing and screening are crucial.
The findings suggest the need for further benefits-related health agency interpretation of and amendments to the ACA, continued Medicaid and innovative Medicare expansion, and incorporation of cancer services values-based considerations at several levels, aimed at reducing group disparities.
《平价医疗法案》及后续改革对美国在BRCA1/2基因咨询与检测以及结直肠癌筛查方面存在差异的种族、农村和性别相关群体带来了权衡取舍，这就需要政策变革。
美国公共卫生协会基因组学论坛政策委员会的一个工作小组每月召开会议，审查现有文献，并确定为边缘化群体提供癌症基因服务的政策替代方案。共收集了589份资料；审查了408份。从2015年2月至2020年9月持续开展相关工作。
自医保交易所开放以来，非裔美国人和拉丁裔的未参保率下降了7%-8%。《平价医疗法案》提高了BRCA1/2检测的可及性，但仍存在一些差异，包括性别差异。农村地区的检测和筛查利用率有所提高。医疗补助扩大以及将医疗保险纳入《平价医疗法案》，使得边缘化群体的结直肠癌筛查率有了不同程度的改善。
迄今为止，癌症基因检测和筛查仅从医疗改革中部分受益。需要关注成本问题并进一步监测新出现的数据。减少差异取决于边缘化群体能否获得私人保险、医疗补助和医疗保险。关注基于价值的设计以及癌症福利转化为实际检测和筛查的方式至关重要。
研究结果表明，需要卫生机构对《平价医疗法案》进行进一步与福利相关的解读和修订，继续扩大医疗补助并创新医疗保险覆盖范围，在多个层面纳入基于癌症服务价值的考量，以减少群体差异。
