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Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minoritiy Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008-2015

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  • White-Means, Shelley I.
  • Osmani, Ahmad Reshad

Abstract

Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women, but mortality rates are higher for black women. Scant evidence exists on how heath care reform policies differentially affect the use of health care services among racial/ethnic minority breast cancer survivors in the US. This study draws on rich, nationally representative data, the 2008-2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle, and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance among breast cancer survivors. Gaps in mammography use significantly declined post-ACA for Hispanic breast cancer survivors compared with white and black survivors. The ACA did not significantly impact disparities in physician utilization. Out-of-pocket prescription drug expenditures declined, narrowing the gap for black and Hispanic survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.

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  • White-Means, Shelley I. & Osmani, Ahmad Reshad, 2018. "Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minoritiy Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008-2015," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 15(9), pages 1-26.
    • Handle: RePEc:zbw:espost:184648
    DOI: 10.3390/ijerph15091860
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    1. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107667273.
    2. Goldzahl, Léontine & Hollard, Guillaume & Jusot, Florence, 2018. "Increasing breast-cancer screening uptake: A randomized controlled experiment," Journal of Health Economics, Elsevier, vol. 58(C), pages 228-252.
    3. Mark Pauly & Scott Harrington & Adam Leive, 2015. ""Sticker Shock" in Individual Insurance under Health Reform?," American Journal of Health Economics, University of Chicago Press, vol. 1(4), pages 494-514, Fall.
    4. Gal Wettstein, 2018. "The Affordable Care Act's insurance market regulations' effect on coverage," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 454-464, March.
    5. Alem, Yonas & Beyene, Abebe D. & Köhlin, Gunnar & Mekonnen, Alemu, 2016. "Modeling household cooking fuel choice: A panel multinomial logit approach," Energy Economics, Elsevier, vol. 59(C), pages 129-137.
    6. Paul V. Grootendorst, 1995. "A comparison of alternative models of prescription drug utilization," Health Economics, John Wiley & Sons, Ltd., vol. 4(3), pages 183-198, May.
    7. Cameron, A Colin & Trivedi, Pravin K, 1986. "Econometric Models Based on Count Data: Comparisons and Applications of Some Estimators and Tests," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 1(1), pages 29-53, January.
    8. Helmut Farbmacher, 2013. "Extensions Of Hurdle Models For Overdispersed Count Data," Health Economics, John Wiley & Sons, Ltd., vol. 22(11), pages 1398-1404, November.
    9. Greene, William, 2008. "Functional forms for the negative binomial model for count data," Economics Letters, Elsevier, vol. 99(3), pages 585-590, June.
    10. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    11. Frean, Molly & Gruber, Jonathan & Sommers, Benjamin D., 2017. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act," Journal of Health Economics, Elsevier, vol. 53(C), pages 72-86.
    12. Hans Van Ophem, 2011. "The frequency of visiting a doctor: Is the decision to go independent of the frequency?," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 26(5), pages 872-879, August.
    13. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    14. Buntin, Melinda Beeuwkes & Zaslavsky, Alan M., 2004. "Too much ado about two-part models and transformation?: Comparing methods of modeling Medicare expenditures," Journal of Health Economics, Elsevier, vol. 23(3), pages 525-542, May.
    15. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    16. Geert Dhaene & J. M. C. Santos Silva, 2012. "Specification and testing of models estimated by quadrature," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 27(2), pages 322-332, March.
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    1. Patrick Opiyo Owili & Miriam Adoyo Muga & Ya-Ting Yang & Yi-Hsin Elsa Hsu, 2019. "Perceived Impact of Taiwan’s National Health Insurance Allocation Strategy: Health Professionals’ Perspective," IJERPH, MDPI, vol. 16(3), pages 1-12, February.
    2. White-Means, Shelley & Gaskin, Darrell J. & Osmani, Ahmad Reshad, 2019. "Intervention and Public Policy Pathways to Achieve Health Care Equity," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 16(14), pages 1-11.
    3. Yordanos M. Tiruneh & Oluwatunmininu Anwoju & Ariel C. Harrison & Martha T. Garcia & Shauna K. Elbers, 2024. "Examining Health-Seeking Behavior among Diverse Ethnic Subgroups within Black Populations in the United States and Canada: A Cross-Sectional Study," IJERPH, MDPI, vol. 21(3), pages 1-12, March.

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