Effects of the ACA on Preventive Care Disparities

Agirdas, Cagdas; Holding, Jordan G

doi:10.1007/s40258-018-0423-5

Cited by 23 publications

(14 citation statements)

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“…Our results show that black women had the lowest decline in mammography and women from other minorities had the lowest decline in Pap test use compared to white women (Table 3 and Table 4). A recent study found the ACA provision to be associated with improved mammography and pap tests among Hispanics and African Americans [31]. Looking at overall utilization, black women had the highest rate of mammogram and pap tests use (mammogram: 81.48%, pap tests: 74.73%) (Table 3 and Table 4).…”

Section: Discussionmentioning

confidence: 99%

Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use

et al. 2019

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Background The Affordable Care Act (ACA) required private insurers and Medicare to cover recommended preventive services without any cost sharing to improve utilization of these services. This study is an attempt to identify the impact of removing cost sharing on mammography and pap test utilization rates. Methods Counterfactual analysis was used to predict what would have been the screening rates in post-ACA if ACA was not there. This was done by estimating a model that examines determinants of dependent variable for the pre-ACA year (pre-ACA year is 2009). The estimated model was then used to predict the dependent variable for the post-ACA year using individual characteristics and other relevant variables unlikely to be affected by ACA (post-ACA year is 2016). Effect of ACA is defined as the difference between the values of dependent variables in post-ACA and the predicted values of dependent variables in the post-ACA year using counterfactual. Results The counterfactual analysis show that the utilization of mammogram and pap test did not improve following ACA. Conclusion Removal of cost-sharing under the ACA did not improve mammography or pap test rates. Therefore, financial barrier may not be an important factor in affecting utilization of the screening tests and policy makers should focus on other non-financial barriers in order to improve coverage of the tests.

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Section: Discussionmentioning

confidence: 99%

Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use

et al. 2019

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“…42 While some studies suggest that higher screening rates reported by non-Hispanic Black individuals may be an artifact associated with overreporting, 43 , 44 other studies suggest that the Patient Protection and Affordable Care Act has been instrumental in countering low screening rates that were reported historically among minority racial and ethnic groups. 45 Should this be the case, we would anticipate changes in disparities in mortality in coming years. Our findings support prior reports of colorectal cancer screening being adversely associated with income and insurance status and skewed toward an older population.…”

Section: Discussionmentioning

confidence: 99%

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

et al. 2021

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IMPORTANCE Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas.OBJECTIVES To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. DESIGN, SETTING, AND PARTICIPANTSThis population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. MAIN OUTCOMES AND MEASURES Adherence to cancer screening based on the US PreventativeServices Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. RESULTSThe overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.

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“…A study found that utilization of preventive services has increased since the implementation of the ACA’s preventive services provisions, but the improvements were minimal across all the essential health benefits (Hong et al, 2017). Another study showed that improvements in use of preventive services were more pronounced among Latinos and non-Latino “blacks” relative to non-Latino “whites” after the implementation of the ACA’s preventive services provisions (Agirdas and Holding, 2018), which suggests that racial and ethnic disparities in preventive services utilization have decreased. Improvements were not observed, however, among Asians as a single group (Agirdas and Holding, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Another study showed that improvements in use of preventive services were more pronounced among Latinos and non-Latino “blacks” relative to non-Latino “whites” after the implementation of the ACA’s preventive services provisions (Agirdas and Holding, 2018), which suggests that racial and ethnic disparities in preventive services utilization have decreased. Improvements were not observed, however, among Asians as a single group (Agirdas and Holding, 2018).…”

Section: Introductionmentioning

confidence: 99%

Utilization of essential preventive health services among Asians after the implementation of the preventive services provisions of the Affordable Care Act

Park

Chen

Grace

et al. 2019

Preventive Medicine Reports

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Utilization of cost-effective essential preventive health services increased after the implementation of the Affordable Care Act’s (ACA) provision that non-grandfathered private insurers provide cost-effective preventive services without cost sharing in 2010. Little is known, however, whether this change is also observed among Asians in the US. We examined patterns of preventive services utilization among Asian subgroups relative to non-Latino whites (whites) after the implementation of the ACA’s preventive services provisions. Using 2013–2016 Medical Expenditure Panel Survey data, we examined utilization trends in preventive services among Asian Indians, Chinese, Filipinos, and other Asians relative to whites. We also ran logistic regression models to estimate the likelihood of having received each of the seven essential preventive services (routine checkups, flu vaccinations, cholesterol screenings, blood pressure checkups, Papanicolaou “pap” tests, mammograms, and colorectal cancer screenings). Compared to whites, Asians had higher rates of utilization of routine checkups, cholesterol screenings, and flu vaccinations, but they had lower utilization rates of blood pressure checkups, pap tests, and mammograms. The patterns of preventive services utilization differed across the Asian subgroups. All Asian subgroups, except for Filipinos, were less likely to have pap tests or mammograms than whites. Moreover, we observed a decreasing trend in having pap tests, mammograms, or colorectal cancer screenings among all Asian subgroups between 2013 and 2016. Our findings suggest that there are low cancer screening rates across Asian subgroups. This indicates the need for programs tailored to specific Asian subgroups to improve cancer screening.

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Effects of the ACA on Preventive Care Disparities

Abstract: Early effects of the ACA's provision of free preventive care are significant for Hispanics and African Americans. Further research is needed for the later years as more individuals became aware of these benefits.

Cited by 23 publications

References 14 publications

Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use

Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

Utilization of essential preventive health services among Asians after the implementation of the preventive services provisions of the Affordable Care Act

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