Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans,The New England Journal of Medicine

当前位置： X-MOL 学术 › N. Engl. J. Med. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans
The New England Journal of Medicine ( IF 96.2 ) Pub Date : 2018-01-17 , DOI: 10.1056/nejmsa1706808
Amal N Trivedi ₁ , Bryan Leyva ₁ , Yoojin Lee ₁ , Orestis A Panagiotou ₁ , Issa J Dahabreh ₁

Affiliation

Background

The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography.

Methods

We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage.

Results

In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, −7.3 to 8.1).

Conclusions

The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.)

Supported by the National Institute on Aging of the National Institutes of Health (award numbers P01AG027296-07S1 and R01AG044374-01).

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

We thank Dr. Elena Elkin of Memorial Sloan Kettering Cancer Center for helpful suggestions on the revision of an earlier version of the manuscript and for sharing data on mammography supply.

Source Information

From the Departments of Health Services, Policy and Practice (A.N.T., B.L., Y.L., O.A.P., I.J.D.), and Epidemiology (I.J.D.), Brown University School of Public Health, and the Providence Veterans Affairs Medical Center (A.N.T.) — both in Providence, RI.

Address reprint requests to Dr. Trivedi at 121 S. Main St., Providence, RI 02903, or at amal_trivedi@brown.edu.

中文翻译：

消除 Medicare Advantage 计划中筛查乳房 X 光检查的费用分摊

背景

《平价医疗法案》(ACA) 要求大多数保险公司和医疗保险计划取消乳房 X 光检查筛查的费用分摊。

方法

我们对参加 24 个 Medicare Advantage 计划的 15,085 名 65 至 74 岁女性进行了两年一次的乳房 X 光检查筛查的双重差分研究，该计划消除了费用分摊，以提供乳房 X 线检查的全面覆盖，而 48 个匹配对照计划中的 52,035 名女性则参加了这项研究。已经并保持了全面覆盖。

结果

在取消费用分摊的计划中，每两年筛查一次乳房X光检查的调整率从取消费用分摊前2年期间的59.9%（95%置信区间[CI]，54.9至65.0）增加至65.4%（95% CI，61.8）至 69.0）在此后 2 年期间。在对照计划中，同一时期每两年进行一次乳房X光检查的比率分别为73.1%（95% CI，69.2至77.0）和72.8%（95% CI，69.7至76.0），差异达5.7个百分点（95% CI，69.7至76.0）。 CI，3.0 至 8.4）。生活在教育程度最高四分位地区的女性之间的差异为 9.8 个百分点（95% CI，4.5 至 15.2），而生活在教育程度最低四分位地区的女性则为 4.3 个百分点（95% CI，0.2 至 8.4）。如双重差分估计所示，在取消费用分摊后，白人女性每两年进行一次乳房 X 光检查的比率增加了 6.5 个百分点（95% CI，3.7 至 9.4），增加了 8.4 个百分点（95% CI，2.5）。黑人女性的这一比例为 14.4），但西班牙裔女性几乎没有变化（0.4 个百分点；95% CI，-7.3 至 8.1）。