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

Abstract

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 18-64years, 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.

Keywords: Affordable Care Act; Cancer screening; Cost-sharing; Insurance; Preventive services.

Fig. 1

Inclusion/exclusion diagram for the study participants in the Medical Expenditure Panel Survey, 2009 and 2011/2012. USPSTF = US Preventive Services Task Force; ACIP = Advisory Committee on Immunization Practices; BP = blood pressure; Pap = Papanicolaou; CRC = colorectal cancer. ¹Women who had hysterectomy were excluded. ²High blood pressure for BP check; high cholesterol for cholesterol check; cervical cancer for Pap test; breast cancer for mammograms; colorectal cancer for CRC screening.