Effects of Massachusetts health reform on the use of clinical preventive services.

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.

SUBMITTER: Okoro CA 

PROVIDER: S-EPMC4139529 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature