Table 3.
Adjusted Prevalence Estimates of Healthcare Access and Clinical Preventive Services* Use and Change Between Pre-reform (2002–2005) and Post-reform (2007–2010) Period, and Massachusetts and Other New England States
| Massachusetts | Other New England States | DiD† | |||||
|---|---|---|---|---|---|---|---|
| Post-reform | Pre-reform | Differences | Post-reform | Pre-reform | Differences | ||
| % (95 % CI) | % (95 % CI) | % (95 % CI) | % (95 % CI) | % (95 % CI) | % (95 % CI) | % (95 % CI) | |
| Healthcare access‡ | |||||||
| Health insurance coverage (n = 208,831) | 94.4 (94.1,94.8) | 90.0 (89.5,90.5) | 4.5¶ (3.8,5.1) | 87.8 (87.4,88.2) | 88.3 (88.0,88.7) | −0.5 (−1.0,0.1) | 4.9¶ (4.1,5.8) |
| Usual source of healthcare (n = 208,545) | 88.8 (88.3,89.3) | 86.9 (86.3,87.5) | 1.9¶ (1.1,2.7) | 86.1 (85.6,86.5) | 85.9 (85.5,86.3) | 0.2 (−0.4,0.8) | 1.7‖ (0.7,2.7) |
| Cost barrier to healthcare in the past 12 months (n = 189,029) | 7.5 (7.1,7.9) | 8.1 (7.6,8.6) | −0.6 (−1.3,0.0) | 11.6 (11.2,12.0) | 10.4 (10.0,10.8) | 1.2¶ (0.7,1.8) | −1.9¶ (−2.8,-1.0) |
| Routine checkup within the past year (n = 145,907) | 74.1 (73.4,74.8) | 70.7 (69.0,72.4) | 3.4¶ (1.6,5.2) | 67.6 (67.1,68.2) | 67.5 (66.3,68.6) | 0.2 (−1.1,1.5) | 3.2‖ (1.0,5.4) |
| Clinical preventive services | |||||||
| Breast cancer screening | |||||||
| Mammogram within the past 2 years, women aged 50–64 years (n = 25,197) | 89.2 (88.0,90.3) | 88.7 (87.0,90.5) | 0.5 (−1.6,2.6) | 85.4 (84.4,86.4) | 86.5 (85.4,87.6) | −1.1 (−2.6,0.4) | 1.6 (−1.0,4.2) |
| Cervical cancer screening | |||||||
| Papanicolaou test within the past 3 years, women aged 21–64 years (n = 50,900) | 93.2 (92.4,94.0) | 93.4 (92.5,94.3) | −0.2 (−1.4,1.0) | 91.1 (90.4,91.8) | 93.2 (92.7,93.8) | −2.1¶ (−3.0,-1.2) | 1.9§ (0.5,3.4) |
| Colorectal cancer screening | |||||||
| Fecal occult blood test within the past year or sigmoidoscopy/colonoscopy within the past 5 years, adults aged 50–64 years (n = 42,421) | 67.1 (65.7,68.4) | 57.1 (54.9,59.3) | 10.0¶ (7.4,12.5) | 62.3 (61.3,63.4) | 56.1 (54.8,57.4) | 6.2¶ (4.6,7.9) | 3.8§ (0.7,6.8) |
| Cardiovascular screening | |||||||
| Cholesterol screening within the past 5 years, men aged 35–64 years and women aged 45–64 years (n = 68,671) | 91.2 (90.5,91.9) | 88.7 (87.7,89.7) | 2.5¶ (1.3,3.7) | 89.1 (88.5,89.6) | 87.4 (86.8,88.1) | 1.7¶ (0.8,2.5) | 0.8 (−0.6,2.3) |
| Immunization | |||||||
| Influenza vaccination within the past year, adults aged 50–64 years (n = 86,934) | 47.9 (46.9,48.9) | 37.1 (35.6,38.5) | 10.8¶ (9.1,12.6) | 47.9 (47.1,48.6) | 38.6 (37.8,39.5) | 9.2¶ (8.1,10.4) | 1.6 (−0.5,3.7) |
% weighted percentage, CI confidence interval, DiD difference-in-differences. Adjusted for gender (where applicable), age (where applicable), race/ethnicity, education, employment status, marital status, household size, annual household income, and general health status
*Affordable care act preventive services mandate (PL 111–148; PL 111–152)
†DiD: difference in adjusted prevalence between post-reform (2007–2010) and pre-reform (2002–2005) years in Massachusetts minus that difference in other New England States
‡Adults aged 18–64 years
§ p <0.05; ‖ p <0.01; and ¶ p <0.001