Effects of Massachusetts Health Reform on the Use of Clinical Preventive Services
- 439 Downloads
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.
To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS.
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).
Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys.
A total of 208,831 survey participants aged 18 to 64 years.
Massachusetts health reform enacted in 2006.
Four healthcare access measures outcomes and five CPS.
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.
Data are self-reported.
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.
KEY WORDShealth insurance healthcare access clinical preventive services
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.
No funding was received for this study.
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.
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.
- 1.CCH Incorporated. Patient Protection and Affordable Care Act; Health Care and Education Reconciliation Act of 2010: text of P.L. 111–148, as signed by the President on March 23, 2010; text of P.L. 111–152, as signed by the President on March 30, 2010: JCT technical explanation of P.L. 111–148 and P.L. 111–152. 2010, Chicago, IL: CCH; 2010Google Scholar
- 2.Bernstein J, Chollet D, Peterson S. Issue brief: how does insurance coverage improve health outcomes? Mathematica Policy Research, Inc.: 2010:1–5.Google Scholar
- 5.Centers for Disease Control and Prevention (CDC). Recommended adult immunization schedule—United States, 2010. MMWR Morbid Mortal Wkly Rep. 2010;59(1):1–4.Google Scholar
- 6.The 187th General Court of the Commonwealth of Massachusetts. Chapter 58 of the Acts of 2006. An act providing access to affordable, quality, accountable health care. April 12, 2006: The 187th General Court of the Commonwealth of Massachusetts; 2006.Google Scholar
- 7.U.S. Department of Health and Human Services. HealthyPeople.gov. How the health care law is making a difference for the people of Massachusetts. 2013; http://www.healthcare.gov/law/information-for-you/ma.html. Accessed March 10, 2014.
- 8.Long SK. On the road to universal coverage: impacts of reform in massachusetts at one year. Health Aff (Millwood). 2008;27(4):w270–84.Google Scholar
- 10.Long SK. Who gained the most under health reform in Massachusetts? Urban Institute; 2008Google Scholar
- 12.Clark CR, Soukup J, Govidarejulu U, Riden HE, Tovar DA, Johnson PA. Lack of access due to costs remains a problem for some in Massachusetts despite the state’s health reforms. Health Reform. 2011;30(2):247–55.Google Scholar
- 14.Tinsley L, Andrews B, Hawk H, Cohen B. Short-term effects of health-care coverage legislation—Massachusetts, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(9):262–7.Google Scholar
- 17.Kolstad JT, Kowalski AE. The impact of health care reform on hospital and preventive care: evidence from Massachusetts. National Bureau of Economic Research; 2010Google Scholar
- 24.Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Operational and User’s Guide. Version 3.0. 2006; http://ftp.cdc.gov/pub/Data/BRFSS/userguide.pdf. Accessed March 10, 2014.
- 26.Li C, Balluz LS, Ford ES, Okoro CA, Zhao G, Pierannunzi C. A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007–2008. Prev Med. 2012;54(6):381–7.PubMedCrossRefGoogle Scholar
- 30.Wooldridge JM. Econometric analysis of cross section and panel data. 2nd ed. MIT Press; 2007.Google Scholar
- 31.SAS Institute Inc. SAS for Windows. Version 9.2 (TS2M0). SAS Institute; 2008.Google Scholar
- 32.Research Triangle Institute. SUDAAN User’s Manual. Research Triangle Institute; 2008.Google Scholar
- 33.Centers for Disease Control and Prevention (CDC). Vital signs: colorectal cancer screening, incidence, and mortality—United States, 2002--2010. MMWR Morb Mortal Wkly Rep. 2011;60(26):884–9.Google Scholar
- 34.Centers for Disease Control and Prevention (CDC). Vital signs: breast cancer screening among women aged 50–74 years—United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(26):813–6.Google Scholar
- 36.Coates RJ, Ogden L, Monroe JA, Buehler J, Yoon PW, Collins JL. Conclusions and future directions for periodic reporting on the use of selected adult clinical preventive services—United States. MMWR Morbid Mortal Wkly Rep. 2012;61(Suppl):73–9.Google Scholar
- 37.Shenson D, Adams M, Bolen J, Anderson L. Routine checkups don’t ensure that seniors get preventive services. J Fam Pract. 2011;60(1):E1–10.Google Scholar
- 38.Guide to Community Preventive Services. The community guide: what works to promote health. 2012; http://www.thecommunityguide.org/library/book/index.html. Accessed March 10, 2014.
- 39.Rodriguez SR, Osborne D, Jacobellis J. Health plan implementation of U.S. Preventive Services Task Force A and B recommendations—Colorado, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(39):1348–50.Google Scholar
- 40.Malhotra K, Heiman HJ. Public health policy is political. Am J Public Health. 2012;102 (7):el; author reply el-2. doi: 10.2105/AJPH.2012.300801
- 43.Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. BRFSS. 2012; http://www.cdc.gov/brfss/. Accessed March 10, 2014.