Determinants of Receipt of Recommended Preventive Services: Implications for the Affordable Care Act.
Am J Public Health. 2014 Jan 16;
Authors: McMorrow S, Kenney GM, Goin D
Objectives. We examined preventive care use by nonelderly adults (aged 18-64 years) before the Affordable Care Act (ACA) and considered the contributions of insurance coverage and other factors to service use patterns. Methods. We used data from the 2005-2010 Medical Expenditure Panel Survey to measure the receipt of 8 recommended preventive services. We examined gaps in receipt of services for adults with incomes below 400% of the federal poverty level compared with higher incomes. We then used a regression-based decomposition analysis to consider factors that explain the gaps in service use by income. Results. There were large income-related disparities in preventive care receipt for nonelderly adults. Differences in insurance coverage explain 25% to 40% of the disparities in preventive service use by income, but education, age, and health status are also important drivers. Conclusions. Expanding coverage to lower-income adults through the ACA is expected to increase their preventive care use. However, the importance of education, age, and health status in explaining income-related gaps in service use indicates that the ACA cannot address all barriers to preventive care and additional interventions may be necessary. (Am J Public Health. Published online ahead of print January 16, 2014: e1-e8. doi:10.2105/AJPH.2013.301569).
PMID: 24432932 [PubMed - as supplied by publisher]