Effects of Massachusetts Health Reform on the Use of Clinical Preventive Services

ABSTRACT BACKGROUND Expansion of health insurance coverage, and hence clinical preventive services (CPS), provides an opportunity for improvements in the health of adults. The degree to which expansion of health insurance coverage affects the use of CPS is unknown. OBJECTIVE To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS. DESIGN We used a difference-in-differences framework to examine change in healthcare access and use of CPS among working-aged adults pre-reform (2002–2005) and post-reform (2007–2010) in Massachusetts compared with change in other New England states (ONES). SETTING Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys. PARTICIPANTS A total of 208,831 survey participants aged 18 to 64 years. INTERVENTION Massachusetts health reform enacted in 2006. MEASUREMENTS Four healthcare access measures outcomes and five CPS. KEY RESULTS The proportions of adults who had health insurance coverage, a healthcare provider, no cost barrier to healthcare, an annual routine checkup, and a colorectal cancer screening increased significantly more in Massachusetts than those in the ONES. In Massachusetts, the prevalence of cervical cancer screening in pre-reform and post-reform periods was about the same; however, the ONES had a decrease of −1.6 percentage points (95 % confidence interval [CI] −2.5, −0.7; p