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

Han, Xuesong; Yabroff, K. Robin; Guy, Gery P.; Zheng, Zhiyuan; Jemal, Ahmedin

doi:10.1016/j.ypmed.2015.07.012

Cited by 76 publications

(59 citation statements)

References 26 publications

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“…20–24 These studies examined population trends without specifically identifying groups that were relieved of cost-sharing requirements. Two quasi-experimental studies, each using data from a single insurer, have reported mixed findings.…”

Section: Discussionmentioning

confidence: 99%

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

et al. 2018

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BACKGROUND The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. METHODS We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage. RESULTS In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, −7.3 to 8.1). CONCLUSIONS The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.)

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Section: Discussionmentioning

confidence: 99%

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

et al. 2018

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“…In contrast, some studies found no effect of the elimination of cost-sharing for screening colonoscopies on participation in CRC screening (32–34), despite the fact that financial concerns is one of the most reported barriers for CRC screening. Substantial financial barriers may persist despite ACA provisions (a predicted 36% of procedures is still subject to coinsurance requirements), reflecting the complexity of current reimbursement policy for both patients and providers.…”

Section: Discussionmentioning

confidence: 99%

Value Of Waiving Coinsurance For Colorectal Cancer Screening In Medicare Beneficiaries

et al. 2017

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Out-of-pocket cost is an important barrier for utilization of health services and a contributor to health disparities. Medicare beneficiaries may face 20% coinsurance for screening colonoscopy with polyp removal or follow-up colonoscopy after a positive screening fecal test. Using an established microsimulation model, we predicted that waiving this coinsurance would result in 1.7 (-13 percent) fewer colorectal cancer deaths and US $17,000 (+0.6 percent ) higher colorectal cancer-related CMS costs per 1000 65-year-olds, when assuming an increase in colonoscopy screening rate from 60 to 70 percent. Waiving coinsurance would increase total cost by US $51,000 (+1.9 percent) per 1000 65-year-olds if screening participation were unchanged. The estimated screening benefits were comparable if fecal testing were the primary modality. Threshold analyses suggested that waiving coinsurance would already be cost-effective if screening rate increased from 60% to 60.6% (US $50,000 willingness-to-pay threshold), reflecting a likely favorable balance of health and cost impact.

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“…From 2009 to 2011, hypertension screening, cholesterol screening, and annual dental visits increased among young adults, though influenza vaccinations did not. 13 Early data hint at increased receipt of other preventive services for adults of all ages 14,15 as ACA provisions for expanded insurance coverage and no co-payments took effect.…”

Section: Introductionmentioning

confidence: 99%

Updated Priorities Among Effective Clinical Preventive Services

et al. 2017

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PURPOSEThe Patient Protection and Affordable Care Act's provisions for firstdollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services. METHODSWe assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures-cost-effectiveness and clinically preventable burden-for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. RESULTSThe 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesityrelated behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations.CONCLUSIONS This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives. 2017;15:14-22. https://doi.org/10.1370/afm.2017. Ann Fam Med INTRODUCTIONT he landscape for prevention in primary care has changed dramatically since the Committee on Clinical Preventive Service Priorities published the first ranking of clinical preventive services in 2001, 1 and the National Commission on Prevention Priorities (NCPP) last updated the list in 2006. 2 A growing evidence base has expanded knowledge about effective preventive services. At the same time, the Patient Protection and Affordable Care Act (ACA) and the pursuit of the Triple Aim 3 seek to expand access to and the efficiency of primary care.Changes in primary care have potential to improve utilization of preventive services. Patient-centered medical homes (PCMHs) have been associated with increased use of preventive services, though it is not clear whether health and financial outcomes are affected. [4][5][6] Accountable Care Organizations (ACOs), when combined with PCMHs, may empower primary care and incentivize change, 7 and ACO shared-savings contracts may encourage hospital systems and specialty providers to become vested stakeholders in evidence-based prevention. Preventive care quality measures and incentives in ACO contracts might ass...

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

Cited by 76 publications

References 26 publications

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

Value Of Waiving Coinsurance For Colorectal Cancer Screening In Medicare Beneficiaries

Updated Priorities Among Effective Clinical Preventive Services

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