Introduction
The Patient Protection and Affordable Care Act requires many health insurance plans
to cover certain clinical preventive services in network with no cost sharing. This
study describes the utilization trends of 8 clinical preventive services by insurance
status and analyzes utilization disparities.
Methods
Data were collected from 2011 to 2019 through the Behavioral Risk Factor Surveillance
System and were analyzed in 2021. Logistic regression and generalized linear modeling
were fitted to calculate the absolute and relative differences by insurance status,
respectively. Annual percentage point change was applied to assess the trends in utilization
and the relative difference.
Results
Trends in utilization ranged from an annual percentage point change high with zoster
vaccination of 8.03 (p<0.01) and a low with cervical cancer screening of −1.01 (p<0.01). Trends (except for HIV testing) were consistently substantially lower among
the uninsured. Utilization among all participants increased for 4 clinical preventive
services, although larger increases were observed among the uninsured for breast and
colon cancer screenings. The utilization of cervical cancer screening decreased, and
the utilization of the other 3 services did not change significantly. The relative
difference between the insured and the uninsured decreased modestly with the greatest
reductions observed for breast cancer screening and zoster vaccination, whereas increases
were observed for HIV testing.
Conclusions
Despite the reduction of cost barriers for the insured, there were larger increases
in utilization among the uninsured, and a narrowed gap was observed over time for
some services. Ongoing efforts to monitor the trends in clinical preventive services
utilization may help identify and evaluate the strategies designed to increase their
use.
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Article Info
Publication History
Published online: May 23, 2021
Identification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
