Screening rates increased after the ACA eliminated out-of-pocket costs, study finds.
After the Affordable Care Act eliminated cost sharing for screening mammograms, their rate of use rose 6 percentage points among older woman for whom such screenings were recommended, a new study in the New England Journal of Medicine finds.
“Out-of-pocket costs can be a potent barrier to receiving recommended preventive care,” says lead author Amal N. Trivedi, MD, MPH, an associate professor of health services, policy, and practice and of medicine. “The study showed that making mammograms free led to an increase in their use. That is good for public health.”
Research shows that requiring deductibles, copayments or other out-of-pocket expenses reduces the use of effective, but often underused, preventive health care services, such as screening mammograms, Trivedi says. One strategy of the ACA is to selectively eliminate copayments for higher-value care, such as screening mammography, to increase the use of these services and improve population health, he says.
The US Preventive Services Task Force recommends that women age 50 to 74 years undergo screening mammography every two years to check for the presence of breast cancer.
In the study, Trivedi and colleagues looked at biennial screening mammography among 15,085 women age 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for the service, compared with 52,035 women in 48 matching Medicare Advantage plans that had and maintained full insurance coverage for mammography.
By examining 24 unique plans, and 72 in total, this is among the largest studies to date of the effects of an ACA cost-sharing provision for a preventive health service.
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