Effects of Massachusetts health reform on the use of clinical preventive services

Abstract

Background: Expansion of health insurance coverage, and hence clinical preventive services (CPS), provides an opportunity for improvements in the health of adults. The degree to which expansion of health insurance coverage affects the use of CPS is unknown.

Objective: To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS.

Design: We used a difference-in-differences framework to examine change in healthcare access and use of CPS among working-aged adults pre-reform (2002-2005) and post-reform (2007-2010) in Massachusetts compared with change in other New England states (ONES).

Setting: Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys.

Participants: A total of 208,831 survey participants aged 18 to 64 years.

Intervention: Massachusetts health reform enacted in 2006.

Measurements: Four healthcare access measures outcomes and five CPS.

Key results: The proportions of adults who had health insurance coverage, a healthcare provider, no cost barrier to healthcare, an annual routine checkup, and a colorectal cancer screening increased significantly more in Massachusetts than those in the ONES. In Massachusetts, the prevalence of cervical cancer screening in pre-reform and post-reform periods was about the same; however, the ONES had a decrease of -1.6 percentage points (95 % confidence interval [CI] -2.5, -0.7; p <0.001). As a result, the prevalence of cervical cancer screening in Massachusetts was increased relative to the ONES (1.7, 95 % CI 0.2, 3.2; p = 0.02). Cholesterol screening, influenza immunization, and breast cancer screening did not improve more in Massachusetts than in the ONES.

Limitations: Data are self-reported.

Conclusions: Health reform may increase healthcare access and improve use of CPS. However, the effects of health reform on CPS use may vary by type of service and by state.

Figure 1

Adjusted prevalence estimates of healthcare access and change between pre-reform (2002–2005) and post-reform (2007–2010) periods. *p <0.001. †, ‡: Statistically significant difference in adjusted prevalence between post-reform and pre-reform years in Massachusetts minus that difference in other New England states (p <0.001 and p <0.01, respectively).

Figure 2

Adjusted prevalence estimates of clinical preventive services and change between pre-reform (2002–2005) and post-reform (2007–2010) periods. *p <0.001. †Statistically significant difference in adjusted prevalence between post-reform and pre-reform years in Massachusetts minus that difference in other New England states (p <0.05).