Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act
Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act
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DOI：
10.1016/j.jacr.2019.01.028
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发表时间：
2019-06-01
影响因子：
4.5
通讯作者：
Dalton, Vanessa K.
中科院分区：
文献类型：
--
作者：
Carlos, Ruth C.;Fendrick, A. Mark;Dalton, Vanessa K.
目的：评估《平价医疗法案》(ACA)和修订后的美国预防服务工作组(USPSTF)指南前后筛查乳房X光检查费用分担和利用的变化。为了比较40岁到49岁的女性和50岁到74岁的女性之间的乳房X光检查费用分担情况。方法：我们使用了来自Clinformatics Data Mart(OptomInsight，明尼苏达州伊甸园草原)的2004年至2014年的患者级别分析文件。我们纳入了年龄在40到74岁之间、没有乳腺癌或乳房切除术病史的女性。我们进行了中断的时间序列分析，评估在ACA实施和USPSTF修订指南之前和之后的成本分担和利用趋势。结果：我们确定了1,763,959名年龄在40到74岁之间的商业保险女性。2004至2014年间，筛查乳房X光检查零成本份额的女性比例从2004年的81.9%上升到2014年的98.2%，随着2010年ACA的实施，比例达到93.1%。随着时间的推移，调整后的中位数成本份额仍然为0美元。最初，筛查利用率在2004年为36.0%，随着USPSTF指南的变化，筛查利用率在2009年达到42.2%的峰值，2014年降至40.0%。比较年龄在40岁到49岁、50岁到和65岁到74岁的女性，所有组中分担费用的比例都随着时间的推移而下降。结论：在ACA之前，绝大多数有商业保险的女性都有乳房X光检查的第一美元保险。在ACA之后，几乎所有的女性都可以获得零成本分享的乳房X光检查。ACA术后乳房X光检查使用量没有增加的部分原因可以归因于USPSTF指南的变化，ACA前没有分担费用的妇女比例很高，以及政策实施前费用分担的水平相对较低。
Objective: To assess changes in screening mammography cost sharing and utilization before and after the Affordable Care Act (ACA) and the revised US Preventive Services Task Force (USPSTF) guidelines. To compare mammography cost sharing between women aged 40 to 49 and those 50 to 74.Methods: We used patient-level analytic files between 2004 and 2014 from Clinformatics Data Mart (OptumInsight, Eden Prairie, Minnesota). We included women 40 to 74 years without a history of breast cancer or mastectomy. We conducted an interrupted time series analyses assessing cost sharing and utilization trends before and after the ACA implementation and USPSTF revised guidelines.Results: We identified 1,763,959 commercially insured women aged 40 to 74 years. Between 2004 and 2014, the proportion of women with zero cost share for screening mammography increased from 81.9% in 2004 to 98.2% in 2014, reaching 93.1% with the 2010 ACA implementation. The adjusted median cost share remained $0 over time. Initially at 36.0% in 2004, screening utilization peaked at 42.2% in 2009 with the USPSTF guidelines change, dropping to 40.0% in 2014. Comparing women aged 40 to 49, 50 to 64, and 65 to 74, the proportion exposed to cost sharing declined over time in all groups.Conclusions: A substantial majority of commercially insured women had first-dollar coverage for mammography before the ACA. After ACA, nearly all women had access to zero cost-share mammography. The lack of an increase in mammography use post-ACA can be partially attributed to a USPSTF guideline change, the high proportion of women without cost sharing before the ACA, and the relatively low levels of cost sharing before the policy implementation.