ArticleJournal of the National Cancer Institute2016
Changes in Receipt of Cancer Screening in Medicare Beneficiaries Following the Affordable Care Act.
Article in Journal of the National Cancer Institute, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Impact of the Affordable Care Act on Colorectal Cancer Outcomes: A Systematic Review.American journal of preventive medicine · 2020Pooled it
- Effect of Behavioral Economic Incentives for Colorectal Cancer Screening in a Randomized Trial.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2021Trial
- Feasibility of Using College Students to Increase Cancer Screening Behaviors Among Their Parents.International journal of environmental research and public health · 2026Article
- Association of municipal rurality and area deprivation with cause-specific mortality in Japan: a nationwide ecological study.BMJ public health · 2026Article
- Cost-Effectiveness of Waiving Coinsurance for Follow-Up Colonoscopy after a Positive Stool-Based Colorectal Screening Test in a Medicare Population.Cancer prevention research (Philadelphia, Pa.) · 2022Article
- Effects of the Colorectal Cancer Control Program.Health economics · 2021Article
- Cancer genetic testing in marginalized groups during an era of evolving healthcare reform.Journal of cancer policy · 2021Review
- Early stage breast cancer treatment and outcome of older patients treated in an oncogeriatric care and a standard care setting: an international comparison.Breast cancer research and treatment · 2020Article
- Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans.Current gastroenterology reports · 2020Review
- Effects of the Affordable Care Act on the Receipt of Colonoscopies among the Insured Elderly.International journal of environmental research and public health · 2020Article
- Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.Health services research · 2019Article
- Prevalence of Out-Of-Pocket Payments for Mammography Screening Among Recently Screened Women.Journal of women's health (2002) · 2019Article
- Adapting to a Shifting Health Care Landscape: Illinois Breast and Cervical Cancer Program Lead Agencies' Perspectives.Health promotion practice · 2019Article
- Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.Preventive medicine · 2019Article
- Effectiveness of Medicare cost-sharing elimination for Cancer screening on utilization.BMC health services research · 2019Article
- Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use.BMC public health · 2019Article
- Impact of The Affordable Care Act's Elimination of Cost-Sharing on the Guideline-Concordant Utilization of Cancer Preventive Screenings in the United States Using Medical Expenditure Panel Survey.Healthcare (Basel, Switzerland) · 2019Article
- Breast Cancer Disparities Among Women in Underserved Communities in the USA.Current breast cancer reports · 2018Article
- Social factors matter in cancer risk and survivorship.Cancer causes & control : CCC · 2018Article
- Medicare Accountable Care Organization Enrollment and Appropriateness of Cancer Screening.JAMA internal medicine · 2018Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundThe Affordable Care Act (ACA) removed copayments for screening mammography and colonoscopy in Medicare beneficiaries, but its clinical impact is unknown.
methodsUsing a 5% random sample of Medicare claims from 2009 through 2012 in individuals age 70 years or older who were due for screening, we examined claims for screening mammography and screening or surveillance colonoscopy for two years prior to ACA (2009-2010) and two years post-ACA (2011-2012). Receipt of the procedures at the patient level was compared across years using generalized estimating equations. Statistical tests were two-sided.
resultsCompared with 2009, we found an increase in mammography uptake during the ACA coverage period, with multivariable odds ratios (MOR) of 1.22 (95% confidence interval [CI] = 1.20 to 1.25, P < .001) for 2011 and 1.17 (95% CI = 1.15 to 1.20, P < .001) for 2012 and less change in 2010 (OR = 1.03, 95% CI = 1.01 to 1.05, P = .01). In contrast to mammography, uptake of screening or surveillance colonoscopy decreased in 2012 (MOR = 0.95, 95% CI = 0.92 to 0.98, P = .002) compared with 2009, with no change in 2010 (MOR = 1.01, 95% CI = 0.99 to 1.04, P = .47) or 2011 (MOR = 1.01, 95% CI = 0.99 to 1.04, P = .34). Other factors associated with procedure receipt included younger age and prior preventive health visits. In an analysis restricted to patients age 70 to 74 years, colonoscopy use increased slightly in 2011 but was unchanged in 2012, and the findings by year for mammography were consistent with the main analysis.
conclusionsFollowing ACA implementation with concomitant reduction in out-of-pocket expenditures, there was a statistically significant increment in mammography uptake but not colonoscopy. This suggests that affordability is a necessary but not sufficient facilitator of preventive services.
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