What does Medicaid expansion mean for cancer screening and prevention? Results from a randomized trial on the impacts of acquiring Medicaid coverage.
What does Medicaid expansion mean for cancer screening and prevention? Results from a randomized trial on the impacts of acquiring Medicaid coverage.
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作者：
Wright BJ;Conlin AK;Allen HL;Tsui J;Carlson MJ;Li HF
俄勒冈州医疗补助彩票提供了一个独特的机会，在随机对照试验的框架内评估医疗保险对癌症筛查率的因果影响。以前关于医疗保险影响的研究几乎总是局限于观察性证据，不能用来进行因果推断。我们前瞻性地跟踪了俄勒冈州医疗补助彩票预订名单中16,204人的代表性小组，收集了医疗补助彩票抽奖前后的数据。我们的小组被分为两组：在医疗补助彩票中被选中的治疗组(n=6,254)和没有被选中的对照组(n=9,950)。我们还创建了一个基于家族癌症病史的高危小组。抽签一年后，我们比较了研究组在癌症筛查率、预防行为和健康状况方面的差异。医疗补助覆盖范围导致几种常见癌症筛查的比率显著提高，特别是在女性中，以及更好的初级保健联系和自我报告的健康结果。我们发现几乎没有证据表明医疗补助增加了可能降低癌症风险的预防性健康行为的采用。医疗补助覆盖范围并没有直接影响可能降低癌症风险的生活方式选择，但它确实提供了获得重要护理和筛查的机会，这些护理和筛查可以帮助更早地发现癌症。这些发现可能会对考虑或寻求扩大医疗补助的州的人口健康产生长期影响。在低收入人群中，获得医疗补助大大增加了某些预防性筛查的使用，特别是在那些家庭患癌症风险较高的人群中。扩大医疗保险可能是通过确保在服务不足或高危人群中更早发现来解决癌症差异的重要战略。
The Oregon Medicaid lottery provided a unique opportunity to assess the causal impacts of health insurance on cancer screening rates within the framework of a randomized controlled trial. Prior studies on the impacts of health insurance have almost always been limited to observational evidence, which cannot be used to make causal inferences. We prospectively followed a representative panel of 16,204 persons from the Oregon Medicaid Lottery Reservation List, collecting data before and after the Medicaid lottery drawings. Our panel was divided into two groups: a treatment group who were selected in the Medicaid lottery (n=6,254) and a control group who were not (n=9,950). We also created an elevated risk subpanel based on family cancer histories. One year after the lottery drawings, we compared differences in cancer screening rates, preventive behaviors, and health status between our study groups. Medicaid coverage resulted in significantly higher rates of several common cancer screenings, especially among women, as well as better primary care connections and self-reported health outcomes. We found little evidence that Medicaid increased the adoption of preventive health behaviors that might reduce cancer risk. Medicaid coverage did not directly impact lifestyle choices that might reduce cancer risk, but it did provide access to important care and screenings that could help detect cancers earlier. These findings could have long-term population health implications for states considering or pursuing Medicaid expansion. Access to Medicaid significantly increased the use of certain preventive screenings in a low-income population, especially among those with elevated family risk for cancer. Health insurance expansion might be an important strategy for addressing cancer disparities by ensuring earlier detection in underserved or at-risk populations.
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影响因子：
9.7
作者：
Allen, Heidi;Baicker, Katherine;Wright, Bill J.
通讯作者：
Wright, Bill J.
影响因子：
120.7
作者：
HADLEY, J;STEINBERG, EP;FEDER, J
通讯作者：
FEDER, J
影响因子：
13.7
作者：
Currie, J;Gruber, J
通讯作者：
Gruber, J
影响因子：
3.7
作者：
Angrist, JD;Imbens, GW;Rubin, DB
通讯作者：
Rubin, DB
DOI：
10.1257/aer.98.5.2242
发表时间：
2008-12
期刊：
The American economic review
影响因子：
--
作者：
Card D;Dobkin C;Maestas N
通讯作者：
Maestas N