Disparities in Cancer Screening: The Role of Medicaid Policy

癌症筛查的差异：医疗补助政策的作用

基本信息

批准号：
8562222
负责人：
Lindsay Marie Sabik
金额：
$ 31.64万
依托单位：
VIRGINIA COMMONWEALTH UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-06 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8562222
关键词：
Address Adult Affect Behavioral Risk Factor Surveillance System Breast Cancer Prevention Caring Cervical Cancer Screening Cost Sharing Costs and Benefits County Data Diagnosis Diagnostic Neoplasm Staging Early Diagnosis Early treatment Eligibility Determination Ensure Ethnic Origin Experimental Designs Federal Government Future Grant Health Health Insurance Healthcare Improve Access Incentives Incidence Inequality Insurance Insurance Coverage Laws Lead Low Income Population Low income Malignant Neoplasms Malignant neoplasm of cervix uteri Measures Medicaid Medical Surveillance Minority Groups Morbidity - disease rate Natural experiment Outcome Parents Patients Physicians Play Policies Population Prevention Preventive Primary Health Care Public Policy Quality of Care Race Research Resources Role Screening for cancer Services Socioeconomic Status Source Stage at Diagnosis Staging Surveys Time Treatment outcome Underserved Population United States Variant Woman Women&apos s Health cancer care cancer diagnosis design disorder prevention experience falls financial incentive flexibility health care service utilization improved malignant breast neoplasm mortality neoplasm registry payment programs public health relevance racial and ethnic disparities screening socioeconomics waiver

项目摘要

DESCRIPTION (provided by applicant): This study examines how existing and new policies that affect the generosity of state Medicaid programs impact breast and cervical cancer screening and related health outcomes among low-income women. There are substantial disparities in breast and cervical cancer diagnosis, treatment, and outcomes in the United States by race/ethnicity and socioeconomic and insurance status. Further, resources to improve access to and quality of care for underserved populations are limited. In recent years, the federal government granted many states increased flexibility to cover low-income adults through Medicaid waivers. Further expansions to Medicaid are anticipated under the Patient Protection and Affordable Care Act (ACA). Current variation in state Medicaid programs and anticipated changes under the ACA provide natural experiments for studying the effect of public insurance on screening for low-income women. We consider the effect of pre- and post-reform variation in eligibility between and within states, as well as the effect of physician payment and patient cost sharing on screening. Understanding how state Medicaid policies affect cancer screening will help guide strategies to reach under-screened populations and add to evidence regarding the costs and benefits of different policies. In addition, we study how variation in Medicaid generosity across states and over time is related to outcomes including cancer incidence and stage at diagnosis, the single most important predictor of survival. The project brings together complementary secondary data from a number of sources. Nationally representative survey data from the Behavioral Risk Factor Surveillance System will be used to study the effects of Medicaid eligibility on breast and cervical cancer screening among low-income populations. Medicaid administrative claims and utilization data will allow us to consider the effects of changes in eligibility as well as physician payment and patient cost sharing on screening among Medicaid enrollees. Surveillance, Epidemiology, and End Results (SEER) cancer registry data will be used to estimate the effects of changes in Medicaid generosity on cancer incidence and stage at diagnosis. Our analytic approach employs a quasi- experimental design to compare changes in outcomes among groups that would have been affected by changes in Medicaid policy (eligibility, payment rates, or cost sharing) to similar groups that were not subject to polcy changes. In addition to considering the effect of policy changes on all low-income women, we will examine whether effects of expansions are larger among racial and ethnic minorities, reducing disparities. This is the first study to consider the effect of recent Medicaid policies regarding eligibility, physician payment, and cost sharing on breast and cervical cancer screening, which are the most important measures for the prevention of breast and cervical cancer morbidity and mortality. The results will provide timely evidence on how Medicaid policy affects women's preventive healthcare utilization and health outcomes.

描述（由申请人提供）：本研究研究了影响州医疗补助计划慷慨的现有和新政策如何影响乳腺癌和宫颈癌筛查以及低收入妇女的相关健康结果。美国通过种族/种族以及社会经济和保险状况在美国乳腺癌和宫颈癌诊断，治疗和结果存在很大差异。此外，改善服务不足人群的获得和护理质量的资源是有限的。近年来，联邦政府授予许多州通过医疗补助豁免来覆盖低收入成年人的灵活性。根据《患者保护和负担得起的护理法》（ACA），预计医疗补助的进一步扩展。当前的州医疗补助计划和ACA预期变化的当前变化提供了研究公共保险对低收入妇女筛查的影响的自然实验。我们考虑了改革前和改革后变化对州之间和内部资格的影响，以及医师支付和患者成本分担对筛查的影响。了解国家医疗补助政策如何影响癌症筛查将有助于指导策略达到筛查不足的人群，并增加有关不同政策的成本和收益的证据。此外，我们研究了整个州和随着时间的时间的医疗补助慷慨差异与诊断时癌症发生率和阶段的结局有关，这是生存的最重要预测指标。该项目将来自许多来源的互补二级数据汇总在一起。来自行为风险因素监视系统的全国代表性调查数据将用于研究医疗补助资格对低收入人群中乳腺癌和宫颈癌筛查的影响。医疗补助行政索赔和利用数据将使我们能够考虑资格变更以及医师付款和患者费用分担对医疗补助参与者筛查的影响。监视，流行病学和最终结果（SEER）癌症登记数据将用于估计医疗补助慷慨对癌症发生率和诊断阶段的影响。我们的分析方法采用了准实验设计来比较不受医疗补助政策（资格，付款率或成本分配）影响的群体之间的结果变化，而不受Polcy变化的影响。除了考虑政策变化对所有低收入妇女的影响外，我们还将研究种族和少数民族的扩张影响是否更大，从而降低了差异。这是第一个考虑最近医疗补助政策对资格，医师支付以及成本分担对乳腺癌和宫颈癌筛查的影响的研究，这是预防乳腺癌和宫颈癌发病率和死亡率的最重要措施。结果将为医疗补助政策如何影响妇女的预防保健利用和健康成果提供及时的证据。