Funding: Jr Investigator Award
This research was developed to fill a critical void in the literature with the introduction of the Patient Protection and Affordable Care Act (ACA) and assess the role of Health Care Reform on CRC screening rates and screening disparities. This study will address the following questions in the National Research Agenda for PHSSR: 1) What public health strategies are most effective in addressing health disparities and/or social determinants of health at local, state, and national levels?, and 2) What policy, system, and administrative strategies are most effective in reducing disparities in the effectiveness, efficiency, and outcomes of public health strategies delivered to racial and ethnic minority and low-income populations? The objective is to provide a comprehensive understanding about the impact of health care reform on overall colorectal cancer screening, disparities in screening, and the role of provider recommendation in mediating these efforts. To accomplish this task, it is necessary to exploit the variation in pre-existing state mandates from 1997 to 2010 and use the mandate states as partial counterfactuals for estimating the effects of ACA mandates. Because the law only affects people who have insurance coverage, we will use the uninsured as another counterfactual in our model. This study will conduct three empirical analyses to examine 1) impact of provider recommendations in mediating screening rates and screening disparities in the United States, 2) impact of health care reform on screening disparities, and 3) to estimate effects of health care reform on overall CRC screening rates. We will conduct a strong quasi-experimental research design using time series statistical methods (difference-in-difference-in-difference model) to examine mandate variations and the effect on CRC screening rates and disparities in screening.
Glen P. Mays, Ph.D., M.P.H.
University of Kentucky
Health Care Reform: Colorectal Cancer Screening Expansion and Health Disparities (PHSSR Research in Progress Webinar, June 2014 recording)