Dissertation/Thesis Abstract

Health system reform and disparities in colorectal cancer screening utilization
by Preston, Michael Anthony, Ph.D., University of Arkansas for Medical Sciences, 2013, 157; 3610356
Abstract (Summary)

This study provides a comprehensive understanding about the impact of health insurance mandates on colorectal cancer (CRC) screening and disparities and whether physician utilization moderates colorectal cancer health disparities. To understand the effects of health care reform on CRC screening, we exploited the variation in pre-existing state mandates from 1997 to 2012 and used the mandated states as a partial counterfactual for estimating the effects of the Affordable Care Act. The target population for this study is men and women 50 years of age and those who are at high risk for colorectal cancer. Three empirical analyses were conducted to estimate the effects of mandates on overall CRC screening rates, to estimate the impact of mandates on CRC screening disparities, and to estimate the impact of physician utilization in moderating screening rates and screening disparities. A quasi-experimental design using time series statistical methods (difference-in-differences model) was conducted to examine variations in state insurance mandates and the effect on colorectal cancer screening rates and disparities in screening. The findings are relevant to the era of Health Care Reform and provide important policy implications for the delivery of preventive services. The adjusted average marginal effects from the difference-in-differences model indicates that insurance mandates increased the probability of being "up-to-date" relative to being non-compliant by 3.4 percentage points after controlling for all other variables in the model (p<0.1). When examining racial and ethnic disparities, being white increased the probability of being "up-to-date" relative to nonwhites by 3.4 percentage points (p<0.05). A separate analysis indicates that having insurance coverage increased the probability of being "up-to-date" by 4.6 percentage points compared to uninsured individuals (p<0.05). Physician utilization increased the probability of being "up-to-date" by 1.5 percentage points, but was not statistically significant. With the introduction of the Affordable Care Act, responsive public health systems require strategies to determine what policy, systems, and administrative strategies are most effective in reducing health disparities. This research demonstrates that insurance mandates increased colorectal cancer screenings by reducing out-of-pocket costs. Future health care reforms that increase access to preventive services, such as CRC screening, are likely with low out-of-pocket costs and will increase the number of people who are "up-to-date".

Indexing (document details)
Advisor: Tilford, J. Mick
Commitee: Bursac, Zoran, Laryea, Jonathan, Mays, Glen P., Thomas, Billy R.
School: University of Arkansas for Medical Sciences
Department: Health Systems Research
School Location: United States -- Arkansas
Source: DAI-B 75/05(E), Dissertation Abstracts International
Subjects: Public health
Keywords: Colorectal cancer screening, Health care reform, Health disparities, Health economics, Preventive services, State health policies
Publication Number: 3610356
ISBN: 978-1-303-70088-0
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