Coverage and Preventive Screening

Abstract

Context. Preventive care has been shown as a high‐value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization. Objective. To determine whether expanding coverage is an effective means to encourage utilization. Design. Comparison of screening rates before and after introduction of deductible‐free coverage. Setting. People insured through large corporations between 2002 and 2006. Patients or Other Participants. Preferred Provider Organization (PPO) enrollees from an employer introducing deductible‐free coverage, and a control group enrolled in a PPO from a second employer with no policy change. Main Outcome Measures. Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears. Intervention. Introduction of first‐dollar coverage (FDC) of preventive services in 2003. Results. After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy). Conclusions. FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out‐of‐pocket costs, but patients' predisposing characteristics merit attention.

Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?

“…This null finding is somewhat inconsistent with prior studies (Goodwin and Anderson, 2012; Meeker et al, 2011; Solanki et al, 2000; Trivedi et al, 2008) and likely due to multiple factors. First, we only have data for 2 years post-ACA implementation while a longer time may be required for changes in cancer screening; recommendations for screening intervals are longer than 1 year for most tests.…”

“…Previous studies have shown that reductions in cost-sharing were associated with increased use of preventive services (Goodwin and Anderson, 2012; Guy, 2010; Meeker et al, 2011; Sabatino et al, 2012; Solanki and Schauffler, 1999; Solanki et al, 2000), although these studies were limited by older data or selected study participants with certain insurance types or employers. Few studies evaluated the effects of cost-sharing on use of preventive services in national population-based samples (Rezayatmand et al, 2013).…”

The long term effects of “Consumer-Directed” health plans on preventive care use

“…For example, some studies (e.g. Charlton et al 2011) included CDHP plans without preventive care carve outs and this first-dollar coverage of preventive care can increase utilization (Meeker et al 2010). …”

Current and (Potential) Future Effects of the Affordable Care Act on HIV Prevention

“…Benefit designs that place all drugs used to treat HIV (even generics) in formulary tiers associated with the highest levels of cost sharing are likely to undermine initiation of, and adherence to, both PrEP and ART [62••, 63]. And, while supportive benefit designs-for example, first dollar coverage for preventive services-improve utilization, they do not necessarily lead to optimal utilization rates [59,[64][65][66][67]. Translating coverage to access and access to receipt of HIV prevention services will require additional investments in change at every level of the system.…”