Impact of ACA’s free screening policy on colorectal cancer outcomes and cost savings : Effect of removal of out-of-pocket cancer screening fee on screening, incidence, mortality, and cost savings

Sammanfattning: Colorectal cancer is the second leading cause of cancer-related deaths worldwide as of 2020. Early detection and diagnosis of colorectal cancer can greatly increase the chances of successful treatment and can also reduce the cost of care including treatment. It’s shown in recent years that the colorectal cancer screening rates have slowed nationwide which impacts the new diagnoses of colorectal cancer (CRC) and the ability to treat it at an early stage to avoid increase in mortality rate. The purpose of this research is to examine the impact of the Affordable Care Act 2010 ‘s policy to remove colorectal cancer screening fee for adults aged 50-75 on screening, incidence, and mortality rate of colorectal cancer using panel data model and employing sequential recursive system of equations method. Since a decision to get screened is an individual’s choice, this study explores methods to increase colorectal cancer screening rate with the help of behavioral economics theories. Results of the study show that Affordable Care Act’s policy to remove colorectal cancer screening fee has a significant impact on both colorectal cancer screening and incidence rates. The ACA’s policy is associated with an increase in colorectal cancer screening rate while associating with a decrease in cancer incidence rate. Relating to the colorectal cancer mortality rate, an effort was made to examine the effect of the Affordable Care Act's policy to remove colorectal cancer screening fee on the overall cost savings resulting from lives saved. However, since this study found no significant impact of the ACA's policy on the mortality rate of colorectal cancer, further exploration in this regard was not pursued. On the other hand, studies conducted to increase colorectal cancer screening rate by applying behavioral economics methods have shown that default method with an opt-out choice and financial incentive with a loss-framed messaging methods are proven effective. Therefore, these methods can be investigated to design and implement a nationwide initiative.