IDEAS home Printed from https://ideas.repec.org/a/zbw/espost/184648.html
   My bibliography  Save this article

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

Author

Listed:
  • 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.

Suggested Citation

  • 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
    as

    Download full text from publisher

    File URL: https://www.econstor.eu/bitstream/10419/184648/3/IJERPH.pdf
    Download Restriction: no
    File URL: https://libkey.io/10.3390/ijerph15091860?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. 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.
    2. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107667273, January.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. A. Colin Cameron & Pravin K. Trivedi, 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.
    9. 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.
    10. 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.
    11. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    12. 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.
    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. Helmut Farbmacher, 2013. "Extensions Of Hurdle Models For Overdispersed Count Data," Health Economics, John Wiley & Sons, Ltd., vol. 22(11), pages 1398-1404, November.
    15. 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.
    16. Greene, William, 2008. "Functional forms for the negative binomial model for count data," Economics Letters, Elsevier, vol. 99(3), pages 585-590, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mark Duggan & Atul Gupta & Emilie Jackson, 2022. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector," American Economic Journal: Economic Policy, American Economic Association, vol. 14(1), pages 111-151, February.
    2. Miyawaki, Atsushi & Noguchi, Haruko & Kobayashi, Yasuki, 2017. "Impact of medical subsidy disqualification on children's healthcare utilization: A difference-in-differences analysis from Japan," Social Science & Medicine, Elsevier, vol. 191(C), pages 89-98.
    3. Borislava Mihaylova & Andrew Briggs & Anthony O'Hagan & Simon G. Thompson, 2011. "Review of statistical methods for analysing healthcare resources and costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 897-916, August.
    4. Helmut Farbmacher, 2013. "Extensions Of Hurdle Models For Overdispersed Count Data," Health Economics, John Wiley & Sons, Ltd., vol. 22(11), pages 1398-1404, November.
    5. Brendan P. M. McCabe & Christopher L. Skeels, 2020. "Distributions You Can Count On …But What’s the Point?," Econometrics, MDPI, vol. 8(1), pages 1-36, March.
    6. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    7. Murthy, Vasudeva N.R. & Okunade, Albert A., 2009. "The core determinants of health expenditure in the African context: Some econometric evidence for policy," Health Policy, Elsevier, vol. 91(1), pages 57-62, June.
    8. Pammolli, Fabio & Salerno, Nicola, 2011. "Le differenze regionali nella governance della spesa sanitaria. La sanità alla sfide del federalismo: il modello SaniRegio di CeRM [Regional differences in the governance of health care expenditure," MPRA Paper 36934, University Library of Munich, Germany.
    9. Raguragavan, Jananee & Hailu, Atakelty & Burton, Michael, 2013. "Economic Valuation of Recreational Fishing in Western Australia: Statewide Random Utility Modelling of Fishing Site Choice Behaviour," Australian Journal of Agricultural and Resource Economics, Australian Agricultural and Resource Economics Society, vol. 57(4), pages 1-20.
    10. Ermagun, Alireza & Stathopoulos, Amanda, 2018. "To bid or not to bid: An empirical study of the supply determinants of crowd-shipping," Transportation Research Part A: Policy and Practice, Elsevier, vol. 116(C), pages 468-483.
    11. Briggs Depew & Isaac D. Swensen, 2019. "The Decision to Carry: The Effect of Crime on Concealed-Carry Applications," Journal of Human Resources, University of Wisconsin Press, vol. 54(4), pages 1121-1153.
    12. Timothy J. Halliday & Randall Q. Akee, 2020. "The impact of Medicaid on medical utilization in a vulnerable population: Evidence from COFA migrants," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1231-1250, October.
    13. Samuel Dodini, 2023. "Insurance Subsidies, the Affordable Care Act, and Financial Stability," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 42(1), pages 97-136, January.
    14. Chee‐Ruey Hsieh & Xuezheng Qin, 2018. "Depression hurts, depression costs: The medical spending attributable to depression and depressive symptoms in China," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 525-544, March.
    15. Kristopher J. Hult & Tomas J. Philipson, 2012. "Public Liabilities and Health Care Policy," NBER Working Papers 18571, National Bureau of Economic Research, Inc.
    16. Courtemanche, Charles & Friedson, Andrew I. & Rees, Daniel I., 2018. "Ambulance Utilization in New York City after the Implementation of the Affordable Care Act," IZA Discussion Papers 11444, Institute of Labor Economics (IZA).
    17. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    18. Russ Kashian & Nicholas Lovett & Yuhan Xue, 2020. "Has the affordable care act affected health care efficiency?," Journal of Regulatory Economics, Springer, vol. 58(2), pages 193-233, December.
    19. Hossein Kavand & Marcel Voia, 2018. "Estimation of Health Care Demand and its Implication on Income Effects of Individuals," Springer Proceedings in Business and Economics, in: William H. Greene & Lynda Khalaf & Paul Makdissi & Robin C. Sickles & Michael Veall & Marcel-Cristia (ed.), Productivity and Inequality, pages 275-304, Springer.
    20. Joan Costa‐Font & Cristina Vilaplana‐Prieto, 2020. "‘More than one red herring'? Heterogeneous effects of ageing on health care utilisation," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 8-29, October.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:zbw:espost:184648. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ZBW - Leibniz Information Centre for Economics (email available below). General contact details of provider: https://edirc.repec.org/data/zbwkide.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.