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Effects of Massachusetts Health Reform on the Use of Clinical Preventive Services

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A Capsule Commentary to this article was published on 15 May 2014

ABSTRACT

BACKGROUND

Expansion of health insurance coverage, and hence clinical preventive services (CPS), provides an opportunity for improvements in the health of adults. The degree to which expansion of health insurance coverage affects the use of CPS is unknown.

OBJECTIVE

To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS.

DESIGN

We used a difference-in-differences framework to examine change in healthcare access and use of CPS among working-aged adults pre-reform (2002–2005) and post-reform (2007–2010) in Massachusetts compared with change in other New England states (ONES).

SETTING

Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys.

PARTICIPANTS

A total of 208,831 survey participants aged 18 to 64 years.

INTERVENTION

Massachusetts health reform enacted in 2006.

MEASUREMENTS

Four healthcare access measures outcomes and five CPS.

KEY RESULTS

The proportions of adults who had health insurance coverage, a healthcare provider, no cost barrier to healthcare, an annual routine checkup, and a colorectal cancer screening increased significantly more in Massachusetts than those in the ONES. In Massachusetts, the prevalence of cervical cancer screening in pre-reform and post-reform periods was about the same; however, the ONES had a decrease of −1.6 percentage points (95 % confidence interval [CI] −2.5, −0.7; p <0.001). As a result, the prevalence of cervical cancer screening in Massachusetts was increased relative to the ONES (1.7, 95 % CI 0.2, 3.2; p = 0.02). Cholesterol screening, influenza immunization, and breast cancer screening did not improve more in Massachusetts than in the ONES.

LIMITATIONS

Data are self-reported.

CONCLUSIONS

Health reform may increase healthcare access and improve use of CPS. However, the effects of health reform on CPS use may vary by type of service and by state.

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Acknowledgements

We thank the BRFSS coordinators in the states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont for their participation in data collection for this analysis and the staff of CDC’s Division of Behavioral Surveillance for their valuable assistance in developing the database for analysis. The authors would also like to express their thanks to Elena A. Hawk, Ph. D., Massachusetts BRFSS coordinator, and Tara W. Strine, Ph. D. for reviewing and commenting on the final draft of this work.

Funding Source

No funding was received for this study.

Prior Presentation

This article was presented at the 46th Annual Society for Epidemiologic Research Meeting, 18–21 June 2013, in Boston, Massachusetts.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Author information

Authors and Affiliations

  1. Centers for Disease Control and Prevention, Division of Behavioral Surveillance, Office of Surveillance, Epidemiology, and Laboratory Services, Public Health Surveillance and Informatics Program Office, 1600 Clifton Rd. NE, M/S E-97, Atlanta, GA, 30333, USA

    Catherine A. Okoro Ph. D. & Ralph J. Coates Ph. D.

  2. Northrop Grumman, and the Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services, Public Health Surveillance and Informatics Program Office, Atlanta, GA, USA

    Satvinder S. Dhingra M. P. H.

  3. Centers for Disease Control and Prevention, Office of Noncommunicable Diseases, Injury and Environmental Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA

    Matthew Zack M. D.

  4. Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, MO, USA

    Eduardo J. Simoes M. D.

Authors
  1. Catherine A. Okoro Ph. D.
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  2. Satvinder S. Dhingra M. P. H.
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  3. Ralph J. Coates Ph. D.
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  4. Matthew Zack M. D.
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  5. Eduardo J. Simoes M. D.
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Corresponding author

Correspondence to Catherine A. Okoro Ph. D..

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Okoro, C.A., Dhingra, S.S., Coates, R.J. et al. Effects of Massachusetts Health Reform on the Use of Clinical Preventive Services. J GEN INTERN MED 29, 1287–1295 (2014). https://doi.org/10.1007/s11606-014-2865-2

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  • DOI: https://doi.org/10.1007/s11606-014-2865-2

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