Determinants of receipt of recommended preventive services: implications for the Affordable Care Act

Abstract

Objectives: We examined preventive care use by nonelderly adults (aged 18-64 years) before the Affordable Care Act (ACA) and considered the contributions of insurance coverage and other factors to service use patterns.

Methods: We used data from the 2005-2010 Medical Expenditure Panel Survey to measure the receipt of 8 recommended preventive services. We examined gaps in receipt of services for adults with incomes below 400% of the federal poverty level compared with higher incomes. We then used a regression-based decomposition analysis to consider factors that explain the gaps in service use by income.

Results: There were large income-related disparities in preventive care receipt for nonelderly adults. Differences in insurance coverage explain 25% to 40% of the disparities in preventive service use by income, but education, age, and health status are also important drivers.

Conclusions: Expanding coverage to lower-income adults through the ACA is expected to increase their preventive care use. However, the importance of education, age, and health status in explaining income-related gaps in service use indicates that the ACA cannot address all barriers to preventive care and additional interventions may be necessary.

FIGURE 1—

Receipt of recommended preventive care by nonelderly adults (aged 18–64 years): 2005–2010 Medical Expenditure Panel Survey, United States. Note. Pap = Papanicolaou. Lower (higher) income adults have incomes below (at or above) 400% of the FPL. Blood pressure check is only available for 2008–2010. Recommended colon cancer screening consists of a colonoscopy in the past 10 years, or a blood stool test in the past year, or a flexible sigmoidoscopy in the past 5 years and a blood stool test in the past 3 years.