title: A slow start: Use of preventive services among seniors following the Affordable Care Act's enhancement of Medicare benefits in the U.S.
abstract: OBJECTIVE
  Beginning January 1st, 2011 in the United States the Affordable Care Act enhanced Medicare coverage for preventive services by eliminating patient cost-sharing under Part B and by introducing an "Annual Wellness Visit," also free-of-charge. We evaluated the early effects of these reforms on utilization of preventive services.
  
  
  METHODS
  We analyzed nationally representative data on 15,044 Medicare seniors from the 2008-2010, and 2012 Medical Expenditure Panel Survey, and examined self-reported cholesterol test, blood pressure check, flu vaccination, endoscopy, fecal occult blood test, prostate specific antigen test, breast examination, and mammography.
  
  
  RESULTS
  Enhanced Medicare benefits had no effects on preventive service utilization among Medicare seniors in 2012, including those with traditional Medicare and no other supplemental insurance, who stood to benefit the most from Part B enhancements.
  
  
  CONCLUSIONS
  The muted overall response can be partly attributed to the fact that most seniors already held insurance that fully covered preventive services. While insurance enhancements can sometimes raise utilization, in the case of preventive services there are other fundamental barriers that require attention. Educating and incentivizing physicians about the need to refer/recommend screenings, and enhancing knowledge among seniors about the importance of preventive care are two steps that would likely go a long way towards increasing utilization.
authors.affiliation: Institute of Gerontology & Department of Economics, Wayne State University, 87 E. Ferry St., Detroit, MI 48202, United States. Electronic address: gail.jensen@wayne.edu.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Jensen
authors.affiliation: Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States. Electronic address: SALLOUMR@mailbox.sc.edu.
authors.forename: Ramzi G
authors.initials: RG
authors.lastname: Salloum
authors.affiliation: Center for Health Policy and Health Services Research, Henry Ford Health System, One Ford Place, Detroit, MI 48202, United States. Electronic address: JHU1@hfhs.org.
authors.forename: Jianhui
authors.initials: J
authors.lastname: Hu
authors.affiliation: Institute of Gerontology & Department of Economics, Wayne State University, 87 E. Ferry St., Detroit, MI 48202, United States. Electronic address: nasim.baghban.ferdows@wayne.edu.
authors.forename: Nasim Baghban
authors.initials: NB
authors.lastname: Ferdows
authors.affiliation: Institute of Gerontology, Wayne State University, 87 E. Ferry St., Detroit, MI 48202, United States. Electronic address: wassim.tarraf@wayne.edu.
authors.forename: Wassim
authors.initials: W
authors.lastname: Tarraf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D006278:Medicare; D058991:Patient Protection and Affordable Care Act; D010808:Physical Examination; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States
keywords: Affordable Care Act; Insurance benefits; Medicare; Preventive services