Utilization Impact of Cost-Sharing Elimination for Preventive Care Services: A Rapid Review

Med Care Res Rev. 2022 Apr;79(2):175-197. doi: 10.1177/10775587211027372. Epub 2021 Jun 22.


Consumer cost-sharing has been shown to diminish utilization of preventive services. Recent efforts, including provisions within the Affordable Care Act, have sought to increase use of preventive care through elimination of cost-sharing for clinically indicated services. We conducted a rapid review of the literature to determine the impact of cost-share elimination on utilization of preventive services. Searches were conducted in PubMed, Scopus, and CINAHL Complete databases as well as in grey literature. A total of 35 articles were included in qualitative synthesis and findings were summarized for three clinical service categories: cancer screenings, contraceptives, and additional services. Impacts of cost-sharing elimination varied depending on clinical service, with a majority of findings showing increases in use. Studies that included socioeconomic status reported that those who were financially vulnerable incurred substantial increases in utilization. Future investigations on additional clinical services are warranted as is research to better elucidate populations who most benefit from cost-sharing elimination.

Keywords: Affordable Care Act; cost-sharing; out-of-pocket; preventive services.

Publication types

  • Review

MeSH terms

  • Cost Sharing*
  • Databases, Factual
  • Early Detection of Cancer
  • Humans
  • Patient Protection and Affordable Care Act*
  • Preventive Health Services
  • United States