Advertisement
Research Article| Volume 58, ISSUE 2, P175-181, February 2020

Download started.

Ok

The Affordable Care Act and Ethnic Disparities in Colorectal Cancer Screening

  • Olive M. Mbah
    Correspondence
    Address correspondence to: Olive M. Mbah, MHS, University of North Carolina, Chapel Hill, 1101 McGavran-Greenberg Hall, CB# 7411, Chapel Hill NC 27599.
    Affiliations
    Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • Alan C. Kinlaw
    Affiliations
    Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • Justin G. Trogdon
    Affiliations
    Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • Stephanie B. Wheeler
    Affiliations
    Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • Cleo A. Samuel
    Affiliations
    Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author

      Introduction

      Cost sharing can deter the use of health services and act as a potential contributor to racial/ethnic disparities in cancer. The Affordable Care Act required most health plans to cover, without cost sharing, preventive services, including colorectal cancer screening. Population-based data were used to estimate the impact of the Affordable Care Act's cost-sharing provision (together with other Affordable Care Act provisions targeting preventive care) on ethnic disparities in colorectal cancer screening, comparing Hispanics with non-Hispanics.

      Methods

      An interrupted time series quasi-experimental analysis was used to examine ethnic differences in colorectal cancer screening pre- and post-implementation of the Affordable Care Act (analysis performed in 2018). The study cohort included insured individuals aged 50–64 years who participated in the Medical Expenditure Panel Survey from 2007 through 2015 (n=44,343).

      Results

      During the pre–Affordable Care Act period, screening rates decreased annually for non-Hispanics by −0.38 per 100 adults per year (95% CI= −0.55, −0.22) but remained level for Hispanics (annual trend per 100 adults: 0.01, 95% CI= −0.34, 0.35). After cost sharing was eliminated in 2011, colorectal cancer screening rates increased for both Hispanics (by 1.29 per 100 adults, 95% CI=0.69, 1.89) and non-Hispanics (by 0.58 per 100 adults, 95% CI=0.18, 0.99). The difference in trend increases between Hispanics and non-Hispanics was not statistically significant (0.70%, 95% CI= −0.24, 1.64).

      Conclusions

      These findings suggest that Affordable Care Act implementation resulted in increased colorectal cancer screening; however, the effect of the law was not significantly different between Hispanics and non-Hispanics. These results provide indications that more needs to be done to reduce racial/ethnic disparities in colorectal cancer screening.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • American Cancer Society
        Colorectal Cancer Facts & Figures 2017–2019.
        American Cancer Society, Atlanta, GA2017
        • Hamman MK
        • Kapinos KA.
        Affordable Care Act provision lowered out-of-pocket cost and increased colonoscopy rates among men in Medicare.
        Health Aff (Millwood). 2015; 34: 2069-2076
        • U.S. Preventive Services Task Force
        Grade definitions after July 2012.
        Published 2012
        • American Cancer Society
        Cancer Facts & Figures 2017.
        American Cancer Society, Atlanta, GA2017
        • Bromley EG
        • May FP
        • Federer L
        • Spiegel BM
        • van Oijen MG
        Explaining persistent under-use of colonoscopic cancer screening in African Americans: a systematic review.
        Prev Med. 2015; 71: 40-48
        • Trivedi AN
        • Leyva B
        • Lee Y
        • Panagiotou OA
        • Dahabreh IJ
        Elimination of cost sharing for screening mammography in Medicare Advantage plans.
        N Engl J Med. 2018; 378: 262-269
        • Trivedi AN
        • Rakowski W
        • Ayanian JZ
        Effect of cost sharing on screening mammography in Medicare health plans.
        N Engl J Med. 2008; 358: 375-383
        • Rubin RJ
        • Mendelson DN.
        Cost sharing in health insurance.
        N Engl J Med. 1995; 333: 733-734
        • Newhouse JP
        • Manning WG
        • Morris CN
        • et al.
        Some interim results from a controlled trial of cost sharing in health insurance.
        N Engl J Med. 1981; 305: 1501-1507
        • Rice T
        • Matsuoka KY.
        The impact of cost-sharing on appropriate utilization and health status: a review of the literature on seniors.
        Med Care Res Rev. 2004; 61: 415-452
        • Swartz K
        Cost-sharing: effects on spending and outcomes.
        Robert Wood Johnson Foundation, Boston, MAPublished 2010
        • Lurie N
        • Manning WG
        • Peterson C
        • Goldberg GA
        • Phelps CA
        • Lillard L
        Preventive care: do we practice what we preach.
        Am J Public Health. 1987; 77: 801-804
        • Solanki G
        • Schauffler HH.
        Cost-sharing and the utilization of clinical preventive services.
        Am J Prev Med. 1999; 17: 127-133
      1. Kaiser Family Foundation. Health and Health Care for Hispanics in the United States. Kaiser Family Foundation.www.kff.org/infographic/health-and-health-care-for-hispanics-in-the-united-states/. Published 2019. Accessed September 10, 2019.

        • Ortega AN
        • Rodriguez HP
        • Vargas Bustamante A
        Policy dilemmas in Latino health care and implementation of the Affordable Care Act.
        Annu Rev Public Health. 2015; 36: 525-544
      2. Livingston G, Minushkin S, Cohn D. Hispanics and Health Care in the United States: Access, Information and Knowledge. Pew Research Center.www.pewresearch.org/hispanic/2008/08/13/hispanics-and-health-care-in-the-united-states-access-information-and-knowledge/. Published 2008. Accessed September 24, 2018.

        • Pleis JR
        • Lethbridge-Cejku M.
        Summary health statistics for U.S. adults: National Health Interview Survey, 2006.
        Vital Health Stat 10. 2007; 235: 1-153
        • Artiga S
        • Ubri P
        • Foutz J
        • Damico A
        Health coverage by race and ethnicity: examining changes under the ACA and the remaining uninsured.
        Published 2016
        • Fedewa SA
        • Goodman M
        • Flanders WD
        • et al.
        Elimination of cost-sharing and receipt of screening for colorectal and breast cancer.
        Cancer. 2015; 121: 3272-3280
        • Koh HK
        • Sebelius KG.
        Promoting prevention through the Affordable Care Act.
        N Engl J Med. 2010; 363: 1296-1299
        • Richman I
        • Asch SM
        • Bhattacharya J
        • Owens DK
        Colorectal cancer screening in the era of the Affordable Care Act.
        J Gen Intern Med. 2016; 31: 315-320
        • Sabik LM
        • Adunlin G.
        The ACA and cancer screening and diagnosis.
        Cancer J. 2017; 23: 151-162
      3. Agency for Health care Research and Quality. Medical Expenditure Panel Survey - Survey Background. Agency for Health care Research and Quality. https://meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp. Accessed September 24, 2018.

        • Yang D
        • Dalton E.
        A unified approach to measuring the effect size between two groups using SAS.
        SAS Glob Forum. 2012; 335 (https://pdfs.semanticscholar.org/6cf4/bd36ca4c90006a5d6563f646a391c255581b.pdf?_ga=2.155892605.71930856.1571423641-1110825170.1571423641. Accessed September 20, 2018): 1-6
        • Austin PC.
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009; 28: 3083-3107
        • Huesch MD
        • Schetter S
        • Segel J
        • Chetlen A
        Evaluation of the “Angelina Jolie Effect” on screening mammography utilization in an academic center.
        J Am Coll Radiol. 2017; 14: 1020-1026
        • Durbin J
        • Watson GS.
        Testing for serial correlation in least squares regression. I.
        Biometrika. 1950; 37: 409-428
        • Wharam JF
        • Zhang F
        • Landon BE
        • LeCates R
        • Soumerai S
        • Ross-Degnan D
        Colorectal cancer screening in a nationwide high-deductible health plan before and after the Affordable Care Act.
        Med Care. 2016; 54: 466-473
        • Penfold RB
        • Zhang F.
        Use of interrupted time series analysis in evaluating health care quality improvements.
        Acad Pediatr. 2013; 13: S38-S44
        • Bernal JL
        • Cummins S
        • Gasparrini A
        Interrupted time series regression for the evaluation of public health interventions: a tutorial.
        Int J Epidemiol. 2017; 46: 348-355
        • Inadomi JM
        • Vijan S
        • Janz NK
        • et al.
        Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies.
        Arch Intern Med. 2012; 172: 575-582
        • Hiatt RA
        • Pérez-Stable EJ
        • Quesenberry Jr., C
        • Sabogal F
        • Otero-Sabogal R
        • McPhee SJ
        Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in northern California.
        Prev Med. 1995; 24: 278-285
      4. Doty MM, Beutel S, Rasmussen PW, Collins SR. Latinos Have Made Coverage Gains but Millions Are Still Uninsured. The Commonwealth Fund.www.commonwealthfund.org/blog/2015/latinos-have-made-coverage-gains-millions-are-still-uninsured. Published 2015. Accessed September 26, 2018.