title: Preventive care for low-income women in massachusetts post-health reform.
abstract: BACKGROUND
  Before enacting health insurance reform in 2006, Massachusetts provided free breast, cervical cancer, and cardiovascular risk screening for low-income uninsured women through a federally subsidized program called the Women's Health Network (WHN). This article examines whether, as women transitioned to insurance to pay for screening tests after health reform legislation was passed, cancer and cardiovascular disease screening changed among WHN participants between 2004 and 2010.
  
  
  METHODS
  We examined claims data from the Massachusetts health insurance exchange and chart review data to measure utilization of mammography, Pap smear, and blood pressure screening among WHN participants in five community health centers in greater Boston. We conducted a longitudinal analysis, by insurance type, using generalized estimating equations to examine the likelihood of screening at recommended intervals in the postreform period compared to the prereform period.
  
  
  RESULTS
  Pre- and postreform, we found a high prevalence of recommended mammography (86% vs. 88%), Pap smear (88% vs. 89%), and blood pressure screening (87% vs. 91%) that was similar or improved for most women postreform. Screening use differed by insurance type. Recommended mammography screening was statistically significantly increased among women with state-subsidized private insurance (odds ratio [OR] 1.58, p<0.05). Women with unsubsidized private insurance or Medicare had decreased Pap smear use postreform. Although screening prevalence was high, 31% of women required state safety-net funds to pay for screening tests.
  
  
  CONCLUSIONS
  Our results suggest a continued need for safety-net programs to support preventive screening among low-income women after implementation of healthcare reform.
authors.affiliation: 1 Division of General Medicine and Primary Care, Harvard Medical School , Boston, Massachusetts.
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Clark
authors.forename: Jane
authors.initials: J
authors.lastname: Soukup
authors.forename: Heather
authors.initials: H
authors.lastname: Riden
authors.forename: Dora
authors.initials: D
authors.lastname: Tovar
authors.forename: Piper
authors.initials: P
authors.lastname: Orton
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Burdick
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Capistran
authors.forename: Jennifer
authors.initials: J
authors.lastname: Morisset
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Browne
authors.forename: Garrett
authors.initials: G
authors.lastname: Fitzmaurice
authors.forename: Paula A
authors.initials: PA
authors.lastname: Johnson
mesh_terms: D000328:Adult; D001795:Blood Pressure Determination / Q000191:economics / Q000706:statistics & numerical data*; D001900:Boston; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D011159:Population Surveillance; D011203:Poverty; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data*