Researchers from University of Toronto Provide Details of New Studies and Findings in the Area of Health and Medicine (Role of Chronic Conditions in Out-of-Pocket Costs for Preventive Care in the US): Health and Medicine

2026 JAN 16 (NewsRx) -- By a News Reporter-Staff News Editor at NewsRx Policy and Law Daily -- Current study results on Health and Medicine have been published. According to news reporting originating in Toronto, Canada, by NewsRx journalists, research stated, “The Patient Protection and Affordable Care Act (ACA) requires private health insurers to cover recommended preventive services with no patient cost-sharing, but patients covered by these provisions still incur out-of-pocket (OOP) costs for which they should be exempt. To date, no work has assessed how gaps in enforcing the ACA’s cost-sharing exemption affect patients with chronic conditions, who have higher OOP costs overall, which increases the financial burden from their health care.”

The news reporters obtained a quote from the research from the University of Toronto, “To determine the relative incidence, magnitude, and determinants of cost-sharing for preventive care among individuals with chronic conditions compared with individuals without such conditions. This cohort study used propensity score matching of patients insured through their employers or the ACA Marketplaces, using claims and remittance data from Symphony Health Solutions’ Integrated DataVerse from 2017 to 2020. Analysis was completed between November 2024 and November 2025. Presence of ambulatory care-sensitive conditions (ACSCs) compared with no chronic conditions. Primary outcomes included the incidence and amount of costs levied for preventive care. Secondary outcomes included the incidence of cost-sharing for preventive care specifically due to service code misclassification and visit complexity. A total of 1 262 414 patients (800 693 female patients [63.42%]; mean [SD] age at the time of visit, 54.46 [12.40] years) received 5 236 253 preventive services over 1 984 354 unique visits. The likelihood of a preventive service resulting in cost-sharing was significantly greater among patients with ACSCs compared with those without ACSCs (17.91% [95% CI, 17.69%-17.95%] vs 15.64% [95% CI, 15.69%-15.95%]; P< .001). Propensity score-matched models found that individuals with ACSCs had a 19.20% increase (95% CI, 18.87%-19.18%; P< .001) in the probability of facing OOP costs for preventive care, and a 20.69% (95% CI, 19.19%-20.91%; P< .001) increase in expected preventive OOP costs overall. These findings suggest that patients with chronic conditions were more likely to experience cost-sharing for preventive care and had greater expected spending overall.”

According to the news reporters, the research concluded: “Standardizing insurer practices regarding cost-sharing exemptions can improve equitable access to high-value preventive care.”

For more information on this research see: Role of Chronic Conditions in Out-of-Pocket Costs for Preventive Care in the US. JAMA Network Open, 2026;9(1). JAMA Network Open can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

Our news correspondents report that additional information may be obtained by contacting Audrey Laporte, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Additional authors for this research include Allan Tran, Eric Nauenberg and Alex Hoagland.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1001/jamanetworkopen.2025.53157. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

The publisher of the journal JAMA Network Open can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

(Our reports deliver fact-based news of research and discoveries from around the world.)