Health Care, Access, Insurance
Racial and Ethnic Disparities in Preventive Service Use after the Full Implementation of the Affordable Care Act.
(School of Public Health (UMD) HLSA Doctoral Student)
Background: Racial/ethnic minorities face substantial access barriers to preventive services. The Patient Protection and Affordable Care Act (ACA) strives to increase insurance coverage and access to preventive services in an effort to reduce unnecessary illness and its associated cost. Purpose: To determine if there are racial/ethnic disparities in preventive services use, what factors are associated with any disparities, and if disparity levels have changed since the full implementation of the ACA in 2014. Methods: We used NHIS (2011-2014) to examine utilization of seven preventive services during the past year: screening for breast (MAM), cervical (PAP), and colon (COLON) cancer, flu shot/spray (FLU), and blood pressure (BP), blood sugar (SUGAR), and cholesterol (CHOL) check. We used mulitvariate logistic regression to evaluate disparities controlling for demographic, socioeconomic, and health access/status variables. Findings: Latinos and African Americans were significantly more likely than non-Latino Whites to receive MAM, PAP, COL, CHOL, and SUGAR and significantly less likely to receive FLU. Latinos were significantly less likely to receive BP and FLU. Asians were significantly more likely to receive FLU and SUGAR and significantly less likely to receive a PAP or BP. Usual source of care, education, and survey year were significantly associated with all services, with those surveyed before 2014 significantly more likely to receive COL, MAM, PAP, and SUGAR and significantly less likely to receive FLU or BP. Conclusions: Our results show that racial/ethnic minorities were significantly more likely to receive several preventive services than non-Latino whites. Results also show that eligible individuals were significantly less likely to report having MAM, PAP, COL, and SUGAR in 2014, compared to before 2014. This suggests that even with increased access to care via the full implementation of the ACA in 2014, preventive service utilization has not necessarily increased.
Importance to public health: