Effects of Massachusetts health reform on the use of clinical preventive services.
BACKGROUND
Expansion of health insurance coverage, and hence clinical preventive services (CPS), provides an opportunity for improvements in the health of adults. The degree to which expansion of health insurance coverage affects the use of CPS is unknown.


OBJECTIVE
To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS.


METHODS
We used a difference-in-differences framework to examine change in healthcare access and use of CPS among working-aged adults pre-reform (2002-2005) and post-reform (2007-2010) in Massachusetts compared with change in other New England states (ONES).


METHODS
Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys.


METHODS
A total of 208,831 survey participants aged 18 to 64 years.


METHODS
Massachusetts health reform enacted in 2006.


METHODS
Four healthcare access measures outcomes and five CPS.


RESULTS
The proportions of adults who had health insurance coverage, a healthcare provider, no cost barrier to healthcare, an annual routine checkup, and a colorectal cancer screening increased significantly more in Massachusetts than those in the ONES. In Massachusetts, the prevalence of cervical cancer screening in pre-reform and post-reform periods was about the same; however, the ONES had a decrease of -1.6 percentage points (95 % confidence interval [CI] -2.5, -0.7; p <0.001). As a result, the prevalence of cervical cancer screening in Massachusetts was increased relative to the ONES (1.7, 95 % CI 0.2, 3.2; p = 0.02). Cholesterol screening, influenza immunization, and breast cancer screening did not improve more in Massachusetts than in the ONES.


CONCLUSIONS
Data are self-reported.


CONCLUSIONS
Health reform may increase healthcare access and improve use of CPS. However, the effects of health reform on CPS use may vary by type of service and by state.
Centers for Disease Control and Prevention, Division of Behavioral Surveillance, Office of Surveillance, Epidemiology, and Laboratory Services, Public Health Surveillance and Informatics Program Office, 1600 Clifton Rd. NE, M/S E-97, Atlanta, GA, 30333, USA, COkoro@cdc.gov.
Catherine A
CA
Okoro
Satvinder S
SS
Dhingra
Ralph J
RJ
Coates
Matthew
M
Zack
Eduardo J
EJ
Simoes
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D018166:Health Care Reform / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D016896:Treatment Outcome; D055815:Young Adult