Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use

Abstract

Background: The Affordable Care Act (ACA) required private insurers and Medicare to cover recommended preventive services without any cost sharing to improve utilization of these services. This study is an attempt to identify the impact of removing cost sharing on mammography and pap test utilization rates.

Methods: Counterfactual analysis was used to predict what would have been the screening rates in post-ACA if ACA was not there. This was done by estimating a model that examines determinants of dependent variable for the pre-ACA year (pre-ACA year is 2009). The estimated model was then used to predict the dependent variable for the post-ACA year using individual characteristics and other relevant variables unlikely to be affected by ACA (post-ACA year is 2016). Effect of ACA is defined as the difference between the values of dependent variables in post-ACA and the predicted values of dependent variables in the post-ACA year using counterfactual.

Results: The counterfactual analysis show that the utilization of mammogram and pap test did not improve following ACA.

Conclusion: Removal of cost-sharing under the ACA did not improve mammography or pap test rates. Therefore, financial barrier may not be an important factor in affecting utilization of the screening tests and policy makers should focus on other non-financial barriers in order to improve coverage of the tests.

Keywords: Affordable care act; Cancer screenings; Cost-sharing; Mammography; Pap tests; Preventive care services.

Fig. 1

Inclusion and exclusion criteria flow chart

Fig. 2

Area under the ROC curve for the estimating models