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

Prev Med. 2015 Sep:78:85-91. doi: 10.1016/j.ypmed.2015.07.012. Epub 2015 Jul 23.


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.

MeSH terms

  • Adolescent
  • Adult
  • Cost Sharing*
  • Early Detection of Cancer / economics
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • Humans
  • Insurance Coverage / economics*
  • Male
  • Medically Uninsured
  • Middle Aged
  • Patient Protection and Affordable Care Act / economics*
  • Preventive Health Services / economics*
  • Preventive Health Services / statistics & numerical data
  • Surveys and Questionnaires
  • United States
  • Young Adult