title: Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?
abstract: BACKGROUND
  An early provision of the Affordable Care Act (ACA) eliminated cost-sharing for a range of recommended preventive services. This provision took effect in September 2010, but little is known about its effect on preventive service use.
  
  
  METHODS
  We evaluated changes in the use of recommended preventive services from 2009 (before the implementation of ACA cost-sharing provision) to 2011/2012 (after the implementation) in the Medical Expenditure Panel Survey, a nationally representative household interview survey in the US. Specifically, we examined: blood pressure check, cholesterol check, flu vaccination, and cervical, breast, and colorectal cancer screening, controlling for demographic characteristics and stratifying by insurance type.
  
  
  RESULTS
  There were 64,280 (21,310 before and 42,970 after the implementation of ACA cost-sharing provision) adults included in the analyses. Receipt of recent blood pressure check, cholesterol check and flu vaccination increased significantly from 2009 to 2011/2012, primarily in the privately insured population aged 18-64years, with adjusted prevalence ratios (95% confidence intervals) 1.03 (1.01-1.05) for blood pressure check, 1.13 (1.09-1.18) for cholesterol check and 1.04 (1.00-1.08) for flu vaccination (all p-values<0.05). However, few changes were observed for cancer screening. We observed little change in the uninsured population.
  
  
  CONCLUSIONS
  These early observations suggest positive benefits from the ACA policy of eliminating cost-sharing for some preventive services. Future research is warranted to monitor and evaluate longer term effects of the ACA on access to care and health outcomes.
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States. Electronic address: xuesong.han@cancer.org.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Han
authors.affiliation: Health Services and Economics Branch, National Cancer Institute, Rockville, MD, United States.
authors.forename: K
authors.initials: K
authors.lastname: Robin Yabroff
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Gery P
authors.initials: GP
authors.lastname: Guy
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States.
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
mesh_terms: D000293:Adolescent; D000328:Adult; D017047:Cost Sharing; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: Affordable Care Act; Cancer screening; Cost-sharing; Insurance; Preventive services