Receipt of Preventive Services After Oregon's Randomized Medicaid Experiment.
BACKGROUND
It is predicted that gaining health insurance via the Affordable Care Act will result in increased rates of preventive health services receipt in the U.S., primarily based on self-reported findings from previous health insurance expansion studies. This study examined the long-term (36-month) impact of Oregon's 2008 randomized Medicaid expansion ("Oregon Experiment") on receipt of 12 preventive care services in community health centers using electronic health record data.


METHODS
Demographic data from adult (aged 19-64 years) Oregon Experiment participants were probabilistically matched to electronic health record data from 49 Oregon community health centers within the OCHIN community health information network (N=10,643). Intent-to-treat analyses compared receipt of preventive services over a 36-month (2008-2011) period among those randomly assigned to apply for Medicaid versus not assigned, and instrumental variable analyses estimated the effect of actually gaining Medicaid coverage on preventive services receipt (data collected in 2012-2014; analysis performed in 2014-2015).


RESULTS
Intent-to-treat analyses revealed statistically significant differences between patients randomly assigned to apply for Medicaid (versus not assigned) for 8 of 12 assessed preventive services. In intent-to-treat analyses, Medicaid coverage significantly increased the odds of receipt of most preventive services (ORs ranging from 1.04 [95% CI=1.02, 1.06] for smoking assessment to 1.27 [95% CI=1.02, 1.57] for mammography).


CONCLUSIONS
Rates of preventive services receipt will likely increase as community health center patients gain insurance through Affordable Care Act expansions. Continued effort is needed to increase health insurance coverage in an effort to decrease health disparities in vulnerable populations.
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon. Electronic address: marinom@ohsu.edu.
Miguel
M
Marino
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon.
Steffani R
SR
Bailey
OCHIN, Inc., Portland, Oregon; Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
Rachel
R
Gold
OCHIN, Inc., Portland, Oregon.
Megan J
MJ
Hoopes
Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon.
Jean P
JP
O'Malley
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon.
Nathalie
N
Huguet
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon.
John
J
Heintzman
Office of Health Analytics, Oregon Health Authority, Salem, Oregon.
Charles
C
Gallia
Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon.
K John
KJ
McConnell
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
Jennifer E
JE
DeVoe
D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009922:Oregon; D058991:Patient Protection and Affordable Care Act; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D044469:Racial Groups; D014481:United States; D055815:Young Adult