Examining public knowledge and preferences for adult preventive services coverage

Costs, Evidence, Context and Values: Journalists' and Policy Experts' Recommendations for U.S. Health Policy Coverage

Health policy plays a critical role in determining a state's or nation's overall population health, and health system change has been a priority for a majority of Americans for at least a decade. News coverage can influence health policy development, but little research has examined the quality of that coverage, in part because no consensus exists regarding what information health policy stories should include. This paper describes a series of in-depth interviews with eight health policy experts and 12 experienced journalists who have covered health policy. While rejecting the notion of strict quality criteria that could be applied to all health policy stories, the interviewees agreed on several factors that would improve health policy coverage. They recommended that health policy stories should include information about financial costs to consumers, evidence that a policy will have its intended effect, historical context for the policy, and "relatable hooks" that help consumers understand which groups a policy will affect and how. In addition, the interviewees stressed the importance of building policy coverage on trustworthy sources representing multiple viewpoints and the need to recognize how audience members' values influence their acceptance and interpretation of evidence. These findings provide an important foundation for future research examining the impact of health policy reporting on both public opinion and public policy development.

The Affordable Care Act's Medicaid Expansion and Impact Along the Cancer-Care Continuum: A Systematic Review

BACKGROUND

Health reform and the merits of Medicaid expansion remain at the top of the legislative agenda, with growing evidence suggesting an impact on cancer care and outcomes. A systematic review was undertaken to assess the association between Medicaid expansion and the goals of the Patient Protection and Affordable Care Act in the context of cancer care. The purpose of this article is to summarize the currently published literature and to determine the effects of Medicaid expansion on outcomes during points along the cancer care continuum.

METHODS

A systematic search for relevant studies was performed in the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases. Three independent observers used an abstraction form to code outcomes and perform a quality and risk of bias assessment using predefined criteria.

RESULTS

A total of 48 studies were identified. The most common outcomes assessed were the impact of Medicaid expansion on insurance coverage (23.4% of studies), followed by evaluation of racial and/or socioeconomic disparities (17.4%) and access to screening (14.5%). Medicaid expansion was associated with increases in coverage for cancer patients and survivors as well as reduced racial- and income-related disparities.

CONCLUSIONS

Medicaid expansion has led to improved access to insurance coverage among cancer patients and survivors, particularly among low-income and minority populations. This review highlights important gaps in the existing oncology literature, including a lack of studies evaluating changes in treatment and access to end-of-life care following implementation of expansion.

Preconception Health: Changing the Paradigm on Well-woman Health

An investment in assuring the health of women, before pregnancy, can reap improved health for women, children, and their families. A paradigm shift of health must occur if perinatal outcomes are to improve, moving beyond reactive care to preventive or preconception care. Preconception health is centered on an assumption a woman is planning on becoming pregnant. But for many women, pregnancy is unplanned and medical conditions may have a negative impact on the trajectory of pregnancy and health. A new paradigm focusing on prevention and wellness can prepare women for lifelong health and healthy perinatal outcomes.

Impact of Medicaid coverage expansion under the Affordable Care Act on mammography and pap tests utilization among low-income women

INTRODUCTION

The Affordable Care Act (ACA) expanded the coverage of Medicaid to include entire population with income below 138% of federal poverty line. It remains unclear whether this policy change has improved access to and utilization of health care, particularly use of mammography and Pap tests among poor women.

METHODS

We used a difference-in-difference (DID) design to estimate the impact of Medicaid expansion on mammography and Pap tests utilization among low-income women. Expansion states are the treatment group and non-expansion states are the control group. The years 2012-13 are the pre-expansion period and 2015-16 are the post-expansion period for the purpose of estimating the DID parameters.

RESULTS

The difference-in-difference estimate show that likelihood of utilizing mammograms did not change significantly among low-income women after the implementation of Medicaid expansion (DID coefficient -0.0476 with t-statistics at -1.26), Pap test decreased (coefficient -0.0615, t-statistics -2.76), and Medicaid enrollment has increased significantly among low-income women living in expansion states (coefficient 0.0889 with t-value of 3.68).

CONCLUSION

Expansion of Medicaid was associated with increased Medicaid enrollment but did not yield near-term improvement in use of mammography and Pap tests among low-income women. Factors beyond health insurance coverage may be important in determining the likelihood of obtaining these screenings. Policy makers should try to identify other barriers to cancer screenings among low-income women in the USA.