Effect of Massachusetts health insurance reform on mammography use and breast cancer stage at diagnosis

Keating, Nancy L.; Kouri, Elena M.; He, Yulei; West, Dee W.; Winer, Eric P.

doi:10.1002/cncr.27757

Cited by 25 publications

(20 citation statements)

References 25 publications

(37 reference statements)

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“…Keating and colleagues reported that expansion of coverage in Massachusetts did not result in an increase of mammography screening or earlier cancer diagnosis. 10 Although our study does not address rates of breast cancer diagnosis, the results indicate that with expansion of Medicaid, these important reconstructive procedures were provided more frequently to this already underserved population. Patients with breast cancer who did not believe they had adequate health care coverage before expansion might not have pursued reconstructive surgery even after implementation of the WHCRA, and having Medicaid coverage might have alleviated some of those concerns.…”

Section: Discussionmentioning

confidence: 79%

The Effect of Medicaid Expansion in New York State on Use of Subspecialty Surgical Procedures by Medicaid Beneficiaries and the Uninsured

Giladi

Aliu

Chung

2014

Journal of the American College of Surgeons

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BACKGROUND Understanding the benefits of Medicaid is crucial as states decide whether to expand Medicaid under the Patient Protection and Affordable Care Act. We used the 2001 Medicaid expansion in New York to evaluate changes in use by Medicaid beneficiaries and the uninsured of breast cancer reconstruction, panniculectomy, and lower-extremity trauma management. METHODS Data for all patients 19 to 64 years old having undergone the selected procedures between 1998 and 2006 were obtained from the State Inpatient Database. We used an interrupted time series using variance weighted least squares regression to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients received the procedures. We also determined the predicted use had there been no expansion. New York Census data were used for population-adjusted case-volume calculations. RESULTS Likelihood of Medicaid as the primary payer increased significantly after expansion, 0.34% per quarter (95% CI, 0.28–0.40), without a decrease in uninsured patients receiving these procedures. This resulted in a 7.2% increase in the proportion of Medicaid beneficiaries receiving these procedures, an additional 1.9 Medicaid cases per quarter per 100,000 New York residents. In subgroup analysis, the proportion of Medicaid beneficiaries increased for breast reconstruction (0.28% per quarter; 95% CI, 0.21–0.35) and panniculectomy (0.19% per quarter; 95% CI, 0.1–0.28) without a decrease for the uninsured. Lower-extremity trauma procedures had a decreasing trend in use by uninsured patients with a slight increase for Medicaid beneficiaries (not significant). CONCLUSIONS Subspecialty surgeons responded to expansion by increasing volume of procedures for Medicaid beneficiaries. This occurred without decline in care for the uninsured, suggesting that Medicaid expansion resulted in increased access for underserved patients. Although more patients received needed care once they had coverage, subgroup analysis identified persistence of additional barriers to use of certain surgical services.

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Section: Discussionmentioning

confidence: 79%

The Effect of Medicaid Expansion in New York State on Use of Subspecialty Surgical Procedures by Medicaid Beneficiaries and the Uninsured

Giladi

Aliu

Chung

2014

Journal of the American College of Surgeons

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“…[6][7][8] Across all income groups in Massachusetts, data from the BRFSS show that mammography use declined during our study period between 2004 and 2010 and could not be directly attributed to healthcare reform practices. 9 It is possible that the sustained high access to mammography screening we observed, which was available via Commonwealth Care insurance in this low-income population, reflects low financial barriers to care, 10 including the absence of physician-visit copayments. Importantly, in the diverse population we studied here, we note that a high percentage of women, particularly Hispanic and non-Hispanic Asian populations, required safety-net funds to pay for their preventive care.…”

Section: Discussionmentioning

confidence: 95%

Preventive Care for Low-Income Women in Massachusetts Post–Health Reform

Clark

Soukup²,

Riden³

et al. 2014

Journal of Women's Health

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Background: Before enacting health insurance reform in 2006, Massachusetts provided free breast, cervical cancer, and cardiovascular risk screening for low-income uninsured women through a federally subsidized program called the Women's Health Network (WHN). This article examines whether, as women transitioned to insurance to pay for screening tests after health reform legislation was passed, cancer and cardiovascular disease screening changed among WHN participants between 2004 and 2010. Methods: We examined claims data from the Massachusetts health insurance exchange and chart review data to measure utilization of mammography, Pap smear, and blood pressure screening among WHN participants in five community health centers in greater Boston. We conducted a longitudinal analysis, by insurance type, using generalized estimating equations to examine the likelihood of screening at recommended intervals in the postreform period compared to the prereform period. Results: Pre-and postreform, we found a high prevalence of recommended mammography (86% vs. 88%), Pap smear (88% vs. 89%), and blood pressure screening (87% vs. 91%) that was similar or improved for most women postreform. Screening use differed by insurance type. Recommended mammography screening was statistically significantly increased among women with state-subsidized private insurance (odds ratio [OR] 1.58, p < 0.05). Women with unsubsidized private insurance or Medicare had decreased Pap smear use postreform. Although screening prevalence was high, 31% of women required state safety-net funds to pay for screening tests. Conclusion: Our results suggest a continued need for safety-net programs to support preventive screening among low-income women after implementation of healthcare reform.

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“…Screening rates may have changed relative to the counterfactual of what rates would have been in the absence of health reform. Keating et al () compare mammography rates before and after Massachusetts reform relative to rates in California and do not find increases in mammography. Their study was limited by the short time period considered pre‐reform and post‐reform and the choice of California, which differs from Massachusetts in geography and population demographics, as a control state.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Near‐Universal Insurance Coverage on Breast and Cervical Cancer Screening: Evidence from Massachusetts

Sabik

2015

Health Economics

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This paper investigates the effect of expansion to near-universal health insurance coverage in Massachusetts on breast and cervical cancer screening. We use data from 2002 to 2010 to compare changes in receipt of mammograms and Pap tests in Massachusetts relative to other New England states. We also consider the effect specifically among low-income women. We find positive effects of Massachusetts health reform on cancer screening, suggesting a 4 to 5% increase in mammograms and 6 to 7% increase in Pap tests annually. Increases in both breast and cervical cancer screening are larger 3 years after the implementation of reform than in the year immediately following, suggesting there may be an adjustment or learning period. Low-income women experience greater increases in breast and cervical cancer screening than the overall population; among women with household income less than 250% of the federal poverty level mammograms increase by approximately 8% and Pap tests by 9%. Overall, Massachusetts health reform appears to have increased breast and cervical cancer screening, particularly among low-income women. Our results suggest reform was successful in promoting preventive care among targeted populations.

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Effect of Massachusetts health insurance reform on mammography use and breast cancer stage at diagnosis

Cited by 25 publications

References 25 publications

The Effect of Medicaid Expansion in New York State on Use of Subspecialty Surgical Procedures by Medicaid Beneficiaries and the Uninsured

The Effect of Medicaid Expansion in New York State on Use of Subspecialty Surgical Procedures by Medicaid Beneficiaries and the Uninsured

Preventive Care for Low-Income Women in Massachusetts Post–Health Reform

The Impact of Near‐Universal Insurance Coverage on Breast and Cervical Cancer Screening: Evidence from Massachusetts

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