Trends in the Utilization of Recommended Clinical Preventive Services, 2011-2019

The Patient Protection and Affordable Care Act requires many health insurance plans to cover certain clinical preventive services in network with no cost sharing. This study describes the utilization trends of 8 clinical preventive services by insurance status and analyzes utilization disparities.

Data were collected from 2011 to 2019 through the Behavioral Risk Factor Surveillance System and were analyzed in 2021. Logistic regression and generalized linear modeling were fitted to calculate the absolute and relative differences by insurance status, respectively. Annual percentage point change was applied to assess the trends in utilization and the relative difference.

Trends in utilization ranged from an annual percentage point change high with zoster vaccination of 8.03 (p<0.01) and a low with cervical cancer screening of -1.01 (p<0.01). Trends (except for HIV testing) were consistently substantially lower among the uninsured. Utilization among all participants increased for 4 clinical preventive services, although larger increases were observed among the uninsured for breast and colon cancer screenings. The utilization of cervical cancer screening decreased, and the utilization of the other 3 services did not change significantly. The relative difference between the insured and the uninsured decreased modestly with the greatest reductions observed for breast cancer screening and zoster vaccination, whereas increases were observed for HIV testing.

Despite the reduction of cost barriers for the insured, there were larger increases in utilization among the uninsured, and a narrowed gap was observed over time for some services. Ongoing efforts to monitor the trends in clinical preventive services utilization may help identify and evaluate the strategies designed to increase their use.