Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans
Menée aux Etats-Unis auprès de 15 085 femmes âgées de 65 à 74 ans et auprès de 52 035 témoins bénéficiant d'une couverture santé complète, cette étude évalue, dans le cadre de la loi sur la protection des patients et les soins abordables ("Obamacare") et des plans de santé "Medicare Advantage Plans", l'effet de la suppression du reste à charge sur le taux de participation au dépistage biennal du cancer du sein par mammographie
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.)
New England Journal of Medicine , résumé, 2018