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Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act.
J Am Coll Radiol. 2019 Jun; 16(6):788-796.JA

Abstract

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.

Authors+Show Affiliations

Department of Radiology, University of Michigan, Ann Arbor, Michigan; Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: rcarlos@med.umich.edu.Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, Michigan.Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30833168

Citation

Carlos, Ruth C., et al. "Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act." Journal of the American College of Radiology : JACR, vol. 16, no. 6, 2019, pp. 788-796.
Carlos RC, Fendrick AM, Kolenic G, et al. Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act. J Am Coll Radiol. 2019;16(6):788-796.
Carlos, R. C., Fendrick, A. M., Kolenic, G., Kamdar, N., Kobernik, E., Bell, S., & Dalton, V. K. (2019). Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act. Journal of the American College of Radiology : JACR, 16(6), 788-796. https://doi.org/10.1016/j.jacr.2019.01.028
Carlos RC, et al. Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act. J Am Coll Radiol. 2019;16(6):788-796. PubMed PMID: 30833168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act. AU - Carlos,Ruth C, AU - Fendrick,A Mark, AU - Kolenic,Giselle, AU - Kamdar,Neil, AU - Kobernik,Emily, AU - Bell,Sarah, AU - Dalton,Vanessa K, Y1 - 2019/03/02/ PY - 2018/12/07/received PY - 2019/01/25/revised PY - 2019/01/27/accepted PY - 2019/3/6/pubmed PY - 2020/6/20/medline PY - 2019/3/6/entrez KW - Affordable Care Act KW - breast cancer screening KW - breast cancer screening utilization KW - cost sharing elimination KW - mammography KW - screening mammography cost share SP - 788 EP - 796 JF - Journal of the American College of Radiology : JACR JO - J Am Coll Radiol VL - 16 IS - 6 N2 - 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. SN - 1558-349X UR - https://www.unboundmedicine.com/medline/citation/30833168/Breast_Screening_Utilization_and_Cost_Sharing_Among_Employed_Insured_Women_After_the_Affordable_Care_Act L2 - https://linkinghub.elsevier.com/retrieve/pii/S1546-1440(19)30128-0 DB - PRIME DP - Unbound Medicine ER -