Effect of Medicaid Expansion on Colorectal Cancer Screening Rates

作者：Yasmin A. Zerhouni, Quoc‐Dien Trinh, Stuart R. Lipsitz, Joel E. Goldberg, Jennifer Irani, Ronald Bleday, Adil Hussain Haider, Nelya Melnitchouk · 发表于：Diseases of the Colon & Rectum · 年份：2018 · DOI：10.1097/dcr.0000000000001260 · 被引用次数：58 · 研究领域：Healthcare Policy and Management、Colorectal Cancer Screening and Detection、Global Cancer Incidence and Screening

BACKGROUND: Colorectal cancer screening decreases incidence and improves survival. Minorities and low-income patients have lower screening rates. The Affordable Care Act increased insurance coverage for low-income Americans by funding Medicaid expansion. Not all states expanded Medicaid. The effect of Medicaid expansion on colorectal cancer screening is unknown. OBJECTIVE: This study aimed to evaluate if Medicaid expansion improved colorectal cancer screening for minorities and low-income patients. DESIGN: We used the Behavior Risk Factor Surveillance System, a nationally representative health-related telephone survey, to compare colorectal cancer screening rates from 2012 to 2016 based on Medicaid expansion status. A difference-in-difference analysis was used to compare the trends. SETTINGS: All states were included in this survey. PATIENTS: Respondents aged 50 to 64 from the early expansion, 2014 expansion, and nonexpansion states were selected. INTERVENTIONS: Medicaid expansion was funded by the Affordable Care Act. MAIN OUTCOME MEASURES: The primary outcome measured was the screening rate based on US Preventive Services Task Force guidelines. RESULTS: Overall screening in expansion states increased (early, +4.5%, p < 0.001; 2014, +1.3%, p = 0.17) compared with nonexpansion states. Screening among low-income respondents increased in early expansion states (+5.7%; p = 0.003), whereas there was no change in 2014 expansion states compared with nonexpansion states (2014, -0.3%...