Disparities in Cancer Screening: The Role of Medicaid Policy

描述（由申请人提供）：本研究探讨了影响州医疗补助计划慷慨程度的现有和新政策如何影响低收入妇女的乳腺癌和宫颈癌筛查及相关健康结果。在美国，乳腺癌和宫颈癌的诊断、治疗和结局在种族/民族、社会经济和保险状况方面存在巨大差异。此外，用于改善服务不足人口获得护理的机会和护理质量的资源有限。近年来，联邦政府给予许多州更大的灵活性，通过医疗补助豁免来覆盖低收入成年人。根据《患者保护和平价医疗法案》（ACA），预计医疗补助将进一步扩大。目前州医疗补助计划的变化和ACA下的预期变化为研究公共保险对低收入妇女筛查的影响提供了自然实验。我们考虑了改革前后各州之间和各州内部的资格变化的影响，以及医生支付和患者分担费用对筛查的影响。了解州医疗补助政策如何影响癌症筛查将有助于指导策略，以达到筛查不足的人群，并增加有关不同政策的成本和效益的证据。此外，我们还研究了各州和一段时间内医疗补助慷慨程度的变化如何与包括癌症发病率和诊断阶段在内的结果相关，这是生存率最重要的预测因素。该项目汇集了来自若干来源的补充性二级数据。来自行为风险因素监测系统的全国代表性调查数据将用于研究医疗补助资格对低收入人群中乳腺癌和宫颈癌筛查的影响。医疗补助的行政索赔和利用数据将使我们能够考虑资格的变化以及医生支付和患者费用分担对医疗补助登记者之间的筛选的影响。监测，流行病学和最终结果（SEER）癌症登记数据将用于估计医疗补助慷慨度变化对癌症发病率和诊断阶段的影响。我们的分析方法采用了准实验设计，比较了受医疗补助政策（资格，支付率或成本分摊）变化影响的群体与不受政策变化影响的类似群体之间的结果变化。除了考虑政策变化对所有低收入妇女的影响外，我们还将研究扩大政策的影响是否在少数种族和族裔中更大，从而缩小差距。这是第一项考虑最近医疗补助政策对乳腺癌和宫颈癌筛查的资格，医生支付和费用分摊的影响的研究，这是预防乳腺癌和宫颈癌发病率和死亡率的最重要措施。研究结果将为医疗补助政策如何影响妇女的预防性医疗保健利用和健康结果提供及时的证据。

DESCRIPTION (provided by applicant): This study examines how existing and new policies that affect the generosity of state Medicaid programs impact breast and cervical cancer screening and related health outcomes among low-income women. There are substantial disparities in breast and cervical cancer diagnosis, treatment, and outcomes in the United States by race/ethnicity and socioeconomic and insurance status. Further, resources to improve access to and quality of care for underserved populations are limited. In recent years, the federal government granted many states increased flexibility to cover low-income adults through Medicaid waivers. Further expansions to Medicaid are anticipated under the Patient Protection and Affordable Care Act (ACA). Current variation in state Medicaid programs and anticipated changes under the ACA provide natural experiments for studying the effect of public insurance on screening for low-income women. We consider the effect of pre- and post-reform variation in eligibility between and within states, as well as the effect of physician payment and patient cost sharing on screening. Understanding how state Medicaid policies affect cancer screening will help guide strategies to reach under-screened populations and add to evidence regarding the costs and benefits of different policies. In addition, we study how variation in Medicaid generosity across states and over time is related to outcomes including cancer incidence and stage at diagnosis, the single most important predictor of survival. The project brings together complementary secondary data from a number of sources. Nationally representative survey data from the Behavioral Risk Factor Surveillance System will be used to study the effects of Medicaid eligibility on breast and cervical cancer screening among low-income populations. Medicaid administrative claims and utilization data will allow us to consider the effects of changes in eligibility as well as physician payment and patient cost sharing on screening among Medicaid enrollees. Surveillance, Epidemiology, and End Results (SEER) cancer registry data will be used to estimate the effects of changes in Medicaid generosity on cancer incidence and stage at diagnosis. Our analytic approach employs a quasi- experimental design to compare changes in outcomes among groups that would have been affected by changes in Medicaid policy (eligibility, payment rates, or cost sharing) to similar groups that were not subject to polcy changes. In addition to considering the effect of policy changes on all low-income women, we will examine whether effects of expansions are larger among racial and ethnic minorities, reducing disparities. This is the first study to consider the effect of recent Medicaid policies regarding eligibility, physician payment, and cost sharing on breast and cervical cancer screening, which are the most important measures for the prevention of breast and cervical cancer morbidity and mortality. The results will provide timely evidence on how Medicaid policy affects women's preventive healthcare utilization and health outcomes.