title: Effect of cost-sharing reductions on preventive service use among Medicare fee-for-service beneficiaries.
abstract: BACKGROUND
  Section 4104 of the Patient Protection and Affordable Care Act (ACA) waives previous cost-sharing requirements for many Medicare-covered preventive services. In 1997, Congress passed similar legislation waiving the deductible only for mammograms and Pap smears. The purpose of this study is to examine the effect of the deductible waiver on mammogram and Pap smear utilization rates.
  
  
  METHODS
  Using 1995-2003 Medicare claims from a sample of female, elderly Medicare fee-for-service beneficiaries, two pre/post analyses were conducted comparing mammogram and Pap smear utilization rates before and after implementation of the deductible waiver. Receipt of screening mammograms and Pap smears served as the outcome measures, and two time measures, representing two post-test observation periods, were used to examine the short- and long-term impacts on utilization.
  
  
  RESULTS
  There was a 20 percent short-term and a 25 percent longer term increase in the probability of having had a mammogram in the four years following the 1997 deductible waiver. Beneficiaries were no more likely to receive a Pap smear following the deductible waiver.
  
  
  CONCLUSIONS
  Elimination of cost sharing may be an effective strategy for increasing preventive service use, but the impact could depend on the characteristics of the procedure, its cost, and the disease and populations it targets. These historical findings suggest that, with implementation of Section 4104, the greatest increases in utilization will be seen for preventive services that screen for diseases with high incidence or prevalence rates that increase with age, that are expensive, and that are performed on a frequent basis.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Goodwin
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Center for Hospital Finance and Management.
authors.forename: Gerard F
authors.initials: GF
authors.lastname: Anderson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017047:Cost Sharing / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003669:Deductibles and Coinsurance / Q000191:economics / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D065006:Papanicolaou Test / Q000191:economics / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: Medicare; Pap smears; Patient Protection and Affordable Care Act (ACA); cost sharing; deductible; mammograms; preventive services