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

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

Han X¹, Robin Yabroff K², Guy GP Jr³, Zheng Z⁴, Jemal A⁴.

Author information

¹Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States. Electronic address: xuesong.han@cancer.org.
²Health Services and Economics Branch, National Cancer Institute, Rockville, MD, United States.
³Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
⁴Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, 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.