The value added includes future health care reforms that increase access to preventive services, such as CRC screening, are likely with lower out-of-pocket costs and will increase the number of people who are considered “up-to-date”. Such policies have been used historically to improve health outcomes, and they are currently being used as public health strategies to increase access to preventive health services in an effort to improve the nation's health. Building a culture of precision public health requires research that includes health delivery model with innovative systems, health policies, and programs that support this vision. Health insurance mandates are effective mechanisms that many state policymakers use to increase the utilization of preventive health services, such as colorectal cancer screening. This study estimated the effects of health insurance mandate variations on colorectal cancer screening post Affordable Care Act (ACA) era. The study analyzed secondary data from the Behavioral Risk Factor Surveillance System (BRFSS) and the NCI State Cancer Legislative Database (SCLD) from 1997 to 2014. BRFSS data were merged with SCLD data by state ID. The target population was U.S. adults, age 50 to 74, who lived in states where health insurance was mandated or nonmandated before and after the implementation of ACA. Using a difference-in-differences (DD) approach with a time-series analysis, we evaluated the effects of health insurance mandates on colorectal cancer screening status based on U.S. Preventive Services Task Force guidelines. The adjusted average marginal effects from the DD model indicate that health insurance mandates increased the probability of up-to-date screenings versus noncompliance by 2.8% points, suggesting that an estimated 2.37 million additional age-eligible persons would receive a screening with such health insurance mandates. Compliant participants' mean age was 65 years and 57% were women (n = 32,569). Our findings are robust for various model specifications. Health insurance mandates that lower out-of-pocket expenses constitute an effective approach to increase colorectal cancer screenings for the population, as a whole. Prevention Relevance: The value added includes future health care reforms that increase access to preventive services, such as CRC screening, are likely with lower out-of-pocket costs and will increase the number of people who are considered “up-to-date”. Such policies have been used historically to improve health outcomes, and they are currently being used as public health strategies to increase access to preventive health services in an effort to improve the nation's health.

中文翻译：

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健康保险承保要求：后 ACA 时代的结直肠癌筛查

增加的价值包括未来的医疗改革，以增加获得预防服务的机会，例如 CRC 筛查，可能会降低自付费用，并将增加被认为是“最新”的人数。此类政策在历史上一直用于改善健康结果，目前正被用作公共卫生战略，以增加获得预防性卫生服务的机会，以改善国家的健康状况。建立精准的公共卫生文化需要研究，其中包括支持这一愿景的创新系统、卫生政策和计划的卫生交付模式。健康保险指令是许多州政策制定者用来提高预防性健康服务（如结直肠癌筛查）利用率的有效机制。本研究估计了平价医疗法案 (ACA) 时代后健康保险授权变化对结直肠癌筛查的影响。该研究分析了 1997 年至 2014 年来自行为风险因素监测系统 (BRFSS) 和 NCI 州癌症立法数据库 (SCLD) 的二手数据。BRFSS 数据按州 ID 与 SCLD 数据合并。目标人群是 50 至 74 岁的美国成年人，他们居住在实施 ACA 前后强制或非强制要求医疗保险的州。我们使用具有时间序列分析的差异差异 (DD) 方法，根据美国预防服务工作组指南评估了健康保险规定对结直肠癌筛查状态的影响。DD 模型调整后的平均边际效应表明，健康保险规定将最新筛查与不合规的概率提高了 2.8%，这表明估计有 237 万额外的符合年龄条件的人将接受此类健康保险的筛查授权。合规参与者的平均年龄为 65 岁，57% 为女性（n = 32,569）。我们的研究结果对于各种模型规格都是稳健的。健康保险要求降低自付费用是增加整个人群结直肠癌筛查的有效方法。预防相关性：增加的价值包括未来的医疗改革，以增加获得预防服务的机会，例如 CRC 筛查，可能具有较低的自付费用，并将增加被认为是“最新”的人数。此类政策在历史上一直用于改善健康结果，目前正被用作公共卫生战略，以增加获得预防性卫生服务的机会，以改善国家的健康状况。