‘Preference-Sensitive’ Procedures Rise Among ACA’s Newly Insured
Knee-replacement surgeries and other "preference-sensitive" medical procedures were "unusually popular" in the first few months of 2014 among newly insured U.S. residents who gained coverage under the Affordable Care Act, according to a recent Society of Actuaries report, the National Journal reports.
The report considers preference-sensitive care as treatments that individuals can delay without causing catastrophic issues. For the report, researchers analyzed insurance claims data in Kansas, which largely is representative of overall U.S. demographics. The researchers compared claims from those who gained insurance under the ACA with those who already had coverage. In addition, the researchers determined which procedures the newly insured individuals sought more often than those who had previously been insured.
According to the report, the newly insured individuals under the ACA disproportionately sought:
- Knee replacements;
- CT scans, which can be used to diagnose cancer and other conditions;
- Gallstone removal surgeries;
- Procedures to alleviate lower-back pain;
- MRIs, which can also be used to diagnose cancer and other conditions; and
- Upper endoscopies, which are used to diagnose potential digestive and other issues related to the esophagus, small intestine and stomach.
Kaiser Family Foundation Vice President Larry Levitt, who was not involved in the analysis, said the findings "show how giving health insurance to people who lacked it before can improve their quality of life."
Levitt also noted the results could provide context for insurers setting premiums for ACA plans sold in 2016. He noted the insurers will be able to base coverage rates on claims data for the newly insured population.
However, Levitt said an increase in such procedures is usually not long term. According to Levitt, individuals seeking such procedures typically become more regular in the health care services they seek after they receive the care they were delaying (Scott, National Journal, 5/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.