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Insurance coverage mandates: Impact of physician utilization in moderating colorectal cancer screening rates - 13/06/18

Doi : 10.1016/j.amjsurg.2018.02.026 
Michael A. Preston a, , Glen P. Mays b , Zoran Bursac c , Billy R. Thomas d , Jonathan Laryea a , J. Mick Tilford e , Michelle Odlum f , Sharla A. Smith g , Ronda S. Henry-Tillman a
a University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA 
b University of Kentucky, Department of Health Management & Policy, College of Public Health, 111 Washington Avenue #201, Lexington, KY 40536-003, USA 
c University of TN Health Science Center, Center for Population Sciences, Department of Preventive Medicine, 66 N Pauline St., Suite 307, Memphis, TN 38163, USA 
d University of Arkansas for Medical Sciences, Department of Pediatrics Neonatology, College of Medicine, 4301 West Markham Street, Little Rock, AR 72205-7199, USA 
e University of Arkansas for Medical Sciences, Department of Health Policy & Management, College of Public Health, 4301 West Markham Street, Little Rock, AR 72205-7199, USA 
f Columbia University, School of Nursing, 617 West 168th Street, Rm 225, New York, NY 10032, USA 
g University of Kansas School of Medicine-Wichita, Department of Preventive Medicine & Public Health, 1010 N. Kansas Street, Wichita, KS 67214, USA 

Corresponding author. University of Arkansas for Medical Sciences, College of Medicine/Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA.University of Arkansas for Medical SciencesCollege of Medicine/Department of SurgeryHealth Initiatives and Disparities Research4301 West Markham Street #827Little RockAR72205-7199USA

Abstract

Precision public health requires research that supports innovative systems and health delivery approaches, programs, and policies that are part of this vision. This study estimated the effects of health insurance mandate (HiM) variations and the effects of physician utilization on moderating colorectal cancer (CRC) screening rates. A time-series analysis using a difference-in-difference-in-differences (DDD) approach was conducted on CRC screenings (1997–2014) using a multivariate logistic framework. Key variables of interest were HiM, CRC screening status, and physician utilization. The adjusted average marginal effects from the DDD model indicate that physician utilization increased the probability of being “up-to-date” vs. non-compliance by 9.9% points (p = 0.007), suggesting that an estimated 8.85 million additional age-eligible persons would receive a CRC screening with HiM and routine physician visits. Routine physician visits and mandates that lower out-of-pocket expenses constitute an effective approach to increasing CRC screenings for persons ready to take advantage of such policies.

Le texte complet de cet article est disponible en PDF.

Highlights

Routine physician visits and health insurance mandates that reduce out-of-pocket expenses represent an effective approach to increase colorectal cancer screenings.
Such policies have historically been used to improve health outcomes, and as public health strategies, they are currently being used to increase preventive health services and, in turn, to improve the nation's health.
Future research examining mandates that lower out-of-pocket costs should continue post-election to inform policymakers.

Le texte complet de cet article est disponible en PDF.

Keywords : Health services research, Health care reform, Health care delivery, Preventive health services, Precision public health


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Vol 215 - N° 6

P. 1004-1010 - juin 2018 Retour au numéro
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