title: Determinants of receipt of recommended preventive services: implications for the Affordable Care Act.
abstract: OBJECTIVE
  We examined preventive care use by nonelderly adults (aged 18-64 years) before the Affordable Care Act (ACA) and considered the contributions of insurance coverage and other factors to service use patterns.
  
  
  METHODS
  We used data from the 2005-2010 Medical Expenditure Panel Survey to measure the receipt of 8 recommended preventive services. We examined gaps in receipt of services for adults with incomes below 400% of the federal poverty level compared with higher incomes. We then used a regression-based decomposition analysis to consider factors that explain the gaps in service use by income.
  
  
  RESULTS
  There were large income-related disparities in preventive care receipt for nonelderly adults. Differences in insurance coverage explain 25% to 40% of the disparities in preventive service use by income, but education, age, and health status are also important drivers.
  
  
  CONCLUSIONS
  Expanding coverage to lower-income adults through the ACA is expected to increase their preventive care use. However, the importance of education, age, and health status in explaining income-related gaps in service use indicates that the ACA cannot address all barriers to preventive care and additional interventions may be necessary.
authors.affiliation: The authors are with the Health Policy Center of the Urban Institute, Washington, DC.
authors.forename: Stacey
authors.initials: S
authors.lastname: McMorrow
authors.forename: Genevieve M
authors.initials: GM
authors.lastname: Kenney
authors.forename: Dana
authors.initials: D
authors.lastname: Goin
mesh_terms: D000293:Adolescent; D000328:Adult; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States