title: Colorectal Cancer Screening in a Nationwide High-deductible Health Plan Before and After the Affordable Care Act.
abstract: BACKGROUND
  Little is known about the effect of the Affordable Care Act's (ACA) elimination of out-of-pocket costs for preventive services. This policy likely reduced out-of-pocket colonoscopy costs most for high-deductible health plan (HDHP) members.
  
  
  OBJECTIVE
  Determine the ACA's impact on colorectal cancer screening among HDHP members.
  
  
  METHODS
  Pre-post with comparison group, constructed before and after the ACA.
  
  
  METHODS
  We studied 2003-2012 administrative claims data of a large national health insurer. HDHP members had 1 year of low-deductible (≤$500) plan enrollment followed by 1 year of HDHP (≥$1000) enrollment after an employer-mandated switch; HDHP enrollment occurred fully after the ACA for 21,605 members and fully before the ACA for 106,609 members. We propensity score-matched contemporaneous low-deductible (≤$500) control group members to both the before-ACA and after-ACA HDHP groups. We examined the 1-year impact of the HDHP switch separately in the before-ACA and after-ACA study cohorts, then compared these changes to estimate ACA effects.
  
  
  METHODS
  Overall colorectal cancer screening, colonoscopy, and fecal-occult blood testing annual rates.
  
  
  RESULTS
  Before the ACA, colorectal cancer screening tests declined by 37/10,000 (-71, -4) among HDHP members versus controls; after the ACA, HDHP members experienced a nonsignificant increase in screening [+52/10,000 (-19,124)]. Corresponding changes in colonoscopy were -55/10,000 (-81, -29) before and +20/10,000 (-38, 78) after the ACA. Thus, the ACA was associated with increased colorectal cancer screening rates [+89/10,000 (11, 168); relative: +9.1% (0.5-17.8)] and screening colonoscopies [+75/10,000 (12-139); relative: +16.4% (2.5-30.3)] among HDHP members.
  
  
  CONCLUSIONS
  The ACA was associated with improved colorectal cancer screening among HDHP members.
authors.affiliation: *Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute†Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Robert
authors.initials: R
authors.lastname: LeCates
authors.forename: Stephen
authors.initials: S
authors.lastname: Soumerai
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D012111:Residence Characteristics; D012959:Socioeconomic Factors