Volume 52 | Number 1 | February 2017

Abstract List

Anupam B. Jena M.D., Ph.D., Jie Huang Ph.D., Bruce Fireman M.A., Vicki Fung Ph.D., Scott Gazelle M.D., M.P.H., Ph.D., Mary Beth Landrum Ph.D., Michael Chernew Ph.D., Joseph P. Newhouse Ph.D., John Hsu M.D., M.B.A.


To study the impact of eliminating cost sharing for screening mammography on mammography rates in a large Medicare Advantage () health plan which in 2010 eliminated cost sharing in anticipation of the Affordable Care Act mandate.

Study Setting

Large health maintenance organization offering individual‐subscriber insurance and employer‐supplemented group insurance.

Study Design

We investigated the impact on breast cancer screening of a policy that eliminated a $20 copayment for screening mammography in 2010 among 53,188 women continuously enrolled from 2007 to 2012 in an individual‐subscriber plan, compared with 42,473 women with employer‐supplemented group insurance in the same health maintenance organization who had full screening coverage during this period. We used differences‐in‐differences analysis to study the impact of cost‐sharing elimination on mammography rates.

Principal Findings

Annual screening rates declined over time for both groups, with similar trends pre‐2010 and a slower decline after 2010 among women whose copayments were eliminated. Among women aged 65–74 years in the individual‐subscriber plan, 44.9 percent received screening in 2009 compared with 40.9 percent in 2012, while 49.5 percent of women in the employer‐supplemented plan received screening in 2009 compared with 44.1 percent in 2012, that is, a difference‐in‐difference effect of 1.4 percentage points less decline in screening among women experiencing the cost‐sharing elimination. Effects were concentrated among women without recent screening. There were no differences by neighborhood socioeconomic status or race/ethnicity.


Eliminating cost sharing for screening mammography was associated with modesty lower decline in screening rates among women with previously low screening adherence.