Colorectal Cancer Screening in a Nationwide High-deductible Health Plan Before and After the Affordable Care Act. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Wharam, J. Frank; Zhang, Fang; Landon, Bruce E.; LeCates, Robert; Soumerai, Stephen; Ross-Degnan, Dennis
• Is Part Of: Medical care. Volume 54:Issue 5(2016)
• Publication Date: 2016-05
• Subjects: Affordable Care Act -- cancer screening -- high-deductible health insurance; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000521
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Little is known about the effect of the Affordable Care Act's (ACA) elimination of out-of-pocket costs for preventive services. This policy likely reduced out-of-pocket colonoscopy costs most for high-deductible health plan (HDHP) members. Objectives: Determine the ACA's impact on colorectal cancer screening among HDHP members. Research Design: Pre-post with comparison group, constructed before and after the ACA. Subjects: We studied 2003–2012 administrative claims data of a large national health insurer. HDHP members had 1 year of low-deductible (⩽$500) plan enrollment followed by 1 year of HDHP (≥$1000) enrollment after an employer-mandated switch; HDHP enrollment occurred fully after the ACA for 21, 605 members and fully before the ACA for 106, 609 members. We propensity score-matched contemporaneous low-deductible (⩽$500) control group members to both the before-ACA and after-ACA HDHP groups. We examined the 1-year impact of the HDHP switch separately in the before-ACA and after-ACA study cohorts, then compared these changes to estimate ACA effects. Measures: Overall colorectal cancer screening, colonoscopy, and fecal-occult blood testing annual rates. Results: Before the ACA, colorectal cancer screening tests declined by 37/10, 000 (−71, −4) among HDHP members versus controls; after the ACA, HDHP members experienced a nonsignificant increase in screening [+52/10, 000 (−19, 124)]. Corresponding changes in colonoscopy were −55/10, 000 (−81, −29) before and +20/10, 000 (−38, 78) after the ACA. Thus, the ACA was associated with increased colorectal cancer screening rates [+89/10, 000 (11, 168); relative: +9.1% (0.5–17.8)] and screening colonoscopies [+75/10, 000 (12–139); relative: +16.4% (2.5–30.3)] among HDHP members. Conclusion: The ACA was associated with improved colorectal cancer screening among HDHP members. Abstract : Supplemental Digital Content is available in the text.