• Catherine A Okoro, Satvinder S Dhingra, Ralph J Coates, Matthew Zack, and Eduardo J Simoes.
• Centers for Disease Control and Prevention, Division of Behavioral Surveillance, Office of Surveillance, Epidemiology, and Laboratory Services, Public Health Surveillance and Informatics Program Office, 1600 Clifton Rd. NE, M/S E-97, Atlanta, GA, 30333, USA, COkoro@cdc.gov.
• J Gen Intern Med. 2014 Sep 1; 29 (9): 128712951287-95.

BackgroundExpansion 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.ObjectiveTo assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS.DesignWe 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).SettingPopulation-based, cross-sectional Behavioral Risk Factor Surveillance System surveys.ParticipantsA total of 208,831 survey participants aged 18 to 64 years.InterventionMassachusetts health reform enacted in 2006.MeasurementsFour healthcare access measures outcomes and five CPS.Key ResultsThe 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 <0.001). As a result, the prevalence of cervical cancer screening in Massachusetts was increased relative to the ONES (1.7, 95 % CI 0.2, 3.2; p = 0.02). Cholesterol screening, influenza immunization, and breast cancer screening did not improve more in Massachusetts than in the ONES.LimitationsData are self-reported.ConclusionsHealth reform may increase healthcare access and improve use of CPS. However, the effects of health reform on CPS use may vary by type of service and by state.

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