Ilana Richman1,2, Steven M Asch3,4, Jay Bhattacharya5, Douglas K Owens3,5. 1. Center for Innovation to Implementation (Ci2i) VA Palo Alto Healthcare System, Palo Alto, CA, USA. irichman@stanford.edu. 2. Center for Primary Care and Outcomes Research/Center for Health Policy, Stanford University School of Medicine, Stanford, CA, USA. irichman@stanford.edu. 3. Center for Innovation to Implementation (Ci2i) VA Palo Alto Healthcare System, Palo Alto, CA, USA. 4. Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA. 5. Center for Primary Care and Outcomes Research/Center for Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
Abstract
BACKGROUND: The Affordable Care Act (ACA) eliminated cost-sharing for evidence-based preventive services in an effort to encourage use. OBJECTIVE: To evaluate use of colorectal cancer (CRC) screening in a national population-based sample before and after implementation of the ACA. DESIGN: Repeated cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) between 2009 and 2012 comparing CRC screening rates before and after implementation of the ACA. PARTICIPANTS: Adults 50-64 with private health insurance and adults 65-75 with Medicare. MAIN MEASURES: Self-reported receipt of screening colonoscopy, sigmoidoscopy, or fecal occult blood test (FOBT) within the past year among those eligible for screening. KEY RESULTS: Our study included 8617 adults aged 50-64 and 3761 adults aged 65-75. MEPS response rates ranged from 58 to 63%. Among adults aged 50-64, 18.9-20.9% received a colonoscopy in the survey year, 0.59-2.1% received a sigmoidoscopy, and 7.9-10.4% received an FOBT. For adults aged 65-75, 23.6-27.7% received a colonoscopy, 1.3-3.2% a sigmoidoscopy, and 13.5-16.4% an FOBT. In adjusted analyses, among participants aged 50-64, there was no increase in yearly rates of colonoscopy (-0.28 percentage points, 95% CI -2.3 to 1.7, p = 0.78), sigmoidoscopy (-1.1%, 95% CI -1.7 to -0.46, p = <0.001), or FOBT (-1.6%, 95% CI -3.2 to -0.03, p = 0.046) post-ACA. For those aged 65-75, rates of colonoscopy (+2.3%, 95% CI -1.4 to 6.0, p = 0.22), sigmoidoscopy (+0.34%, 95% CI 0.88 to 1.6, p = 0.58) and FOBT (-0.65, 95% CI -4.1 to 2.8, p = 0.72) did not increase. Among those aged 65-75 with Medicare and no additional insurance, the use of colonoscopy rose by 12.0% (95% CI 3.3 to 20.8, p = 0.007). Among participants with Medicare living in poverty, colonoscopy use also increased (+5.7%, 95% CI 0.18 to 11.3, p = 0.043). CONCLUSIONS: Eliminating cost-sharing for CRC screening has not resulted in changes in the use of CRC screening services for many Americans, although use may have increased in the post-ACA period among some Medicare beneficiaries.
BACKGROUND: The Affordable Care Act (ACA) eliminated cost-sharing for evidence-based preventive services in an effort to encourage use. OBJECTIVE: To evaluate use of colorectal cancer (CRC) screening in a national population-based sample before and after implementation of the ACA. DESIGN: Repeated cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) between 2009 and 2012 comparing CRC screening rates before and after implementation of the ACA. PARTICIPANTS: Adults 50-64 with private health insurance and adults 65-75 with Medicare. MAIN MEASURES: Self-reported receipt of screening colonoscopy, sigmoidoscopy, or fecal occult blood test (FOBT) within the past year among those eligible for screening. KEY RESULTS: Our study included 8617 adults aged 50-64 and 3761 adults aged 65-75. MEPS response rates ranged from 58 to 63%. Among adults aged 50-64, 18.9-20.9% received a colonoscopy in the survey year, 0.59-2.1% received a sigmoidoscopy, and 7.9-10.4% received an FOBT. For adults aged 65-75, 23.6-27.7% received a colonoscopy, 1.3-3.2% a sigmoidoscopy, and 13.5-16.4% an FOBT. In adjusted analyses, among participants aged 50-64, there was no increase in yearly rates of colonoscopy (-0.28 percentage points, 95% CI -2.3 to 1.7, p = 0.78), sigmoidoscopy (-1.1%, 95% CI -1.7 to -0.46, p = <0.001), or FOBT (-1.6%, 95% CI -3.2 to -0.03, p = 0.046) post-ACA. For those aged 65-75, rates of colonoscopy (+2.3%, 95% CI -1.4 to 6.0, p = 0.22), sigmoidoscopy (+0.34%, 95% CI 0.88 to 1.6, p = 0.58) and FOBT (-0.65, 95% CI -4.1 to 2.8, p = 0.72) did not increase. Among those aged 65-75 with Medicare and no additional insurance, the use of colonoscopy rose by 12.0% (95% CI 3.3 to 20.8, p = 0.007). Among participants with Medicare living in poverty, colonoscopy use also increased (+5.7%, 95% CI 0.18 to 11.3, p = 0.043). CONCLUSIONS: Eliminating cost-sharing for CRC screening has not resulted in changes in the use of CRC screening services for many Americans, although use may have increased in the post-ACA period among some Medicare beneficiaries.
Entities:
Keywords:
colorectal cancer; health care reform; health insurance; preventive care
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