A slow start: Use of preventive services among seniors following the Affordable Care Act's enhancement of Medicare benefits in the U.S.

Jensen, Gail A.; Salloum, Ramzi G.; Hu, Jianhui; Ferdows, Nasim B.; Tarraf, Wassim

doi:10.1016/j.ypmed.2015.03.023

Cited by 47 publications

(62 citation statements)

References 14 publications

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“…In fact, the receipt rate of these three preventive services among those aged ≥65 years old was much higher than those aged 18–64 years at baseline (90% vs. 72% for blood pressure check; 79% vs. 45% for cholesterol check; and 69% vs. 33% for flu vaccination in 2009, respectively), leaving less room for improvements or possibly creating a ceiling effect for evaluating the impact of the ACA provisions. Our generally null findings among the elderly were consistent with results from a recently study in Medicare population (Jensen et al, 2015). …”

Section: Discussionsupporting

confidence: 93%

Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?

Han

Yabroff

Guy

et al. 2015

Preventive Medicine

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Background An early provision of the Affordable Care Act (ACA) eliminated cost-sharing for a range of recommended preventive services. This provision took effect in September 2010, but little is known about its effect on preventive service use. Methods We evaluated changes in the use of recommended preventive services from 2009 (before the implementation of ACA cost-sharing provision) to 2011/2012 (after the implementation) in the Medical Expenditure Panel Survey, a nationally representative household interview survey in the US. Specifically, we examined: blood pressure check, cholesterol check, flu vaccination, and cervical, breast, and colorectal cancer screening, controlling for demographic characteristics and stratifying by insurance type. Results There were 64,280 (21,310 before and 42,970 after the implementation of ACA cost-sharing provision) adults included in the analyses. Receipt of recent blood pressure check, cholesterol check and flu vaccination increased significantly from 2009 to 2011/2012, primarily in the privately insured population aged 18–64 years, with adjusted prevalence ratios (95% confidence intervals) 1.03 (1.01–1.05) for blood pressure check, 1.13 (1.09–1.18) for cholesterol check and 1.04 (1.00–1.08) for flu vaccination (all p-values < 0.05). However, few changes were observed for cancer screening. We observed little change in the uninsured population. Conclusions These early observations suggest positive benefits from the ACA policy of eliminating cost-sharing for some preventive services. Future research is warranted to monitor and evaluate longer term effects of the ACA on access to care and health outcomes.

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Section: Discussionsupporting

confidence: 93%

Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?

Han

Yabroff

Guy

et al. 2015

Preventive Medicine

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“…26,33,34 Beginning January 1, 2011, there is no cost to Medicare beneficiaries for annual screening mammograms because the Affordable Care Act enhanced benefits for clinical preventive service under Medicare and eliminated patient cost-sharing for recommended preventive services. 35 Our results indicated that payment incentive to beneficiaries has a limited impact on screening mammography. Further research is needed to understand why this group of women did not have a screening.…”

Section: Discussionmentioning

confidence: 67%

Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations

Chang

Bynum

Onega

et al. 2016

Journal of Women's Health

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Background: It is uncertain how changes in the U.S. Preventive Services Task Force breast cancer screening recommendations (from annual to biennial mammography screening in women aged 50-74 and grading the evidence as insufficient for screening in women aged 75 and older) have affected mammography use among Medicare beneficiaries. Materials and Methods: Cohort study of 12 million Medicare fee-for-service women aged 65-74 and 75 and older to measure changes in 3-year screening use, 2007-2009 (before) and 2010-2012 (after), defined by two measures-proportion screened and frequency of screening by age, race/ethnicity, and hospital referral region. Results: Fewer women were screened, but with similar frequency after 2009 for both age groups (after vs. before: age 65-74: 60.1% vs. 60.8% screened, 2.1 vs. 2.1 mammograms per screened woman; age 75 and older: 31.7% vs. 33.6% screened, 1.9 vs. 1.9 mammograms per screened woman; all p < 0.05). Black women were the only subgroup with an increase in screening use, and for both age groups (after vs. before: age 65-74: 55.4% vs. 54.0% screened and 2.0 vs. 1.9 mammograms per screened woman; age 75 and older: 28.5% vs. 27.9% screened and 1.8 vs. 1.8 mammograms per screened woman; all p < 0.05). Regional change patterns in screening were more similar between age groups (Pearson correlation r = 0.781 for proportion screened; r = 0.840 for frequency of screening) than between black versus nonblack women (Pearson correlation r = 0.221 for proportion screened; r = 0.212 for frequency of screening). Conclusions: Changes in screening mammography use for Medicare women are not fully aligned with the 2009 recommendations.

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“…These results align with previous studies that have measured primary care physician's activities after disclosure of cognitive test results . Although TSH and serum B12 testing may be performed in the evaluation of depression (as well as other conditions such as anemia), also included in the AWV assessment, prior studies found no difference in the rates of depression in beneficiaries with and without an AWV . Additional research is needed to understand the association between the AWV benefit and diagnostic, evaluation, and management patterns over longer time horizons.…”

Section: Discussionmentioning

confidence: 99%

One‐Year Effect of the Medicare Annual Wellness Visit on Detection of Cognitive Impairment: A Cohort Study

Fowler

Campbell

Pohl

et al. 2018

J American Geriatrics Society

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A slow start: Use of preventive services among seniors following the Affordable Care Act's enhancement of Medicare benefits in the U.S.

Cited by 47 publications

References 14 publications

Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?

Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?

Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations

One‐Year Effect of the Medicare Annual Wellness Visit on Detection of Cognitive Impairment: A Cohort Study

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