{"title":"2011-2017年《平价医疗法案》对美国18-64岁慢性疾病成年人健康可及性的影响","authors":"Hongying Dai, Ali S Khan","doi":"10.1097/PHH.0000000000001225","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>The 2010 Patient Protection and Affordable Care Act (ACA) eliminated the restrictions on preexisting conditions for health care coverage. Little is known about the effects of the ACA on health care access among individuals with chronic health conditions.</p><p><strong>Objective: </strong>To determine how the implementations of the ACA affected health care access for adults with chronic health conditions.</p><p><strong>Design, setting, and participants: </strong>Data from respondents aged 18 to 64 years to the 2011-2017 nationally representative Behavioral Risk Factor Surveillance System (BFRSS) who reported preexisting chronic health conditions (n = 1 133 609). Multivariable logistic regression models were used to examine the changes in health care access from 2011-2013 (before the ACA) to 2015-2017 (after the ACA), overall and by sociodemographic groups.</p><p><strong>Main outcomes measures: </strong>Self-reported access to health care coverage, skipped doctor visits because of cost issues, and having a routine checkup in the past 12 months.</p><p><strong>Results: </strong>The percentage of adults with chronic health conditions having no health care coverage declined from 19.7% before the ACA to 11.9% after the ACA (adjusted odds ratio [AOR] = 0.5], P < .001), the percentage of skipped doctor visits because of cost declined from 24.6% to 20.0% (AOR = 0.8, P < .001), and the percentage with an annual routine checkup increased from 69.6% to 72.5% (AOR = 1.1, P < .001). The improvements in health care access were pronounced across sociodemographic groups after the ACA, especially among some disadvantaged groups (ie, young adults, non-Hispanic Blacks and Hispanics, and those with low income and low education). However, substantial disparities in health care access persisted, especially among individuals with low socioeconomic status.</p><p><strong>Conclusions: </strong>This study identifies substantial improvements in health care access among adults with chronic health conditions after ACA implementation, especially among disadvantaged populations.</p>","PeriodicalId":296123,"journal":{"name":"Journal of public health management and practice : JPHMP","volume":" ","pages":"E85-E91"},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"The Effects of the Affordable Care Act on Health Access Among Adults Aged 18-64 Years With Chronic Health Conditions in the United States, 2011-2017.\",\"authors\":\"Hongying Dai, Ali S Khan\",\"doi\":\"10.1097/PHH.0000000000001225\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>The 2010 Patient Protection and Affordable Care Act (ACA) eliminated the restrictions on preexisting conditions for health care coverage. Little is known about the effects of the ACA on health care access among individuals with chronic health conditions.</p><p><strong>Objective: </strong>To determine how the implementations of the ACA affected health care access for adults with chronic health conditions.</p><p><strong>Design, setting, and participants: </strong>Data from respondents aged 18 to 64 years to the 2011-2017 nationally representative Behavioral Risk Factor Surveillance System (BFRSS) who reported preexisting chronic health conditions (n = 1 133 609). Multivariable logistic regression models were used to examine the changes in health care access from 2011-2013 (before the ACA) to 2015-2017 (after the ACA), overall and by sociodemographic groups.</p><p><strong>Main outcomes measures: </strong>Self-reported access to health care coverage, skipped doctor visits because of cost issues, and having a routine checkup in the past 12 months.</p><p><strong>Results: </strong>The percentage of adults with chronic health conditions having no health care coverage declined from 19.7% before the ACA to 11.9% after the ACA (adjusted odds ratio [AOR] = 0.5], P < .001), the percentage of skipped doctor visits because of cost declined from 24.6% to 20.0% (AOR = 0.8, P < .001), and the percentage with an annual routine checkup increased from 69.6% to 72.5% (AOR = 1.1, P < .001). The improvements in health care access were pronounced across sociodemographic groups after the ACA, especially among some disadvantaged groups (ie, young adults, non-Hispanic Blacks and Hispanics, and those with low income and low education). However, substantial disparities in health care access persisted, especially among individuals with low socioeconomic status.</p><p><strong>Conclusions: </strong>This study identifies substantial improvements in health care access among adults with chronic health conditions after ACA implementation, especially among disadvantaged populations.</p>\",\"PeriodicalId\":296123,\"journal\":{\"name\":\"Journal of public health management and practice : JPHMP\",\"volume\":\" \",\"pages\":\"E85-E91\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of public health management and practice : JPHMP\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PHH.0000000000001225\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of public health management and practice : JPHMP","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PHH.0000000000001225","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
摘要
背景:2010年的《患者保护和平价医疗法案》(ACA)取消了对已存在疾病的医疗保险限制。人们对ACA对慢性疾病患者获得医疗保健的影响知之甚少。目的:确定ACA的实施如何影响成人慢性疾病患者的医疗保健可及性。设计、环境和参与者:数据来自2011-2017年全国代表性行为风险因素监测系统(BFRSS)中报告既往存在慢性健康状况的18至64岁受访者(n = 1 133 609)。使用多变量逻辑回归模型来检查2011-2013年(ACA之前)至2015-2017年(ACA之后)医疗保健可及性的变化，总体上和按社会人口统计学群体进行。主要结果指标:自我报告获得医疗保险的情况，因费用问题而不去看医生，以及在过去12个月内进行例行检查。结果:成人慢性病患者无医疗保险的比例由ACA实施前的19.7%下降到ACA实施后的11.9%(调整优势比[AOR] = 0.5]， P < 0.001)，因费用原因不就诊的比例由24.6%下降到20.0% (AOR = 0.8, P < 0.001)，每年例行体检的比例由69.6%上升到72.5% (AOR = 1.1, P < 0.001)。ACA实施后，各个社会人口群体在获得医疗保健方面的改善都很明显，特别是在一些弱势群体中(即年轻人、非西班牙裔黑人和西班牙裔以及低收入和低教育程度群体)。然而，在获得保健服务方面仍然存在巨大差距，特别是在社会经济地位较低的个人之间。结论:本研究确定了ACA实施后慢性健康状况的成年人，特别是弱势群体获得医疗保健的实质性改善。
The Effects of the Affordable Care Act on Health Access Among Adults Aged 18-64 Years With Chronic Health Conditions in the United States, 2011-2017.
Context: The 2010 Patient Protection and Affordable Care Act (ACA) eliminated the restrictions on preexisting conditions for health care coverage. Little is known about the effects of the ACA on health care access among individuals with chronic health conditions.
Objective: To determine how the implementations of the ACA affected health care access for adults with chronic health conditions.
Design, setting, and participants: Data from respondents aged 18 to 64 years to the 2011-2017 nationally representative Behavioral Risk Factor Surveillance System (BFRSS) who reported preexisting chronic health conditions (n = 1 133 609). Multivariable logistic regression models were used to examine the changes in health care access from 2011-2013 (before the ACA) to 2015-2017 (after the ACA), overall and by sociodemographic groups.
Main outcomes measures: Self-reported access to health care coverage, skipped doctor visits because of cost issues, and having a routine checkup in the past 12 months.
Results: The percentage of adults with chronic health conditions having no health care coverage declined from 19.7% before the ACA to 11.9% after the ACA (adjusted odds ratio [AOR] = 0.5], P < .001), the percentage of skipped doctor visits because of cost declined from 24.6% to 20.0% (AOR = 0.8, P < .001), and the percentage with an annual routine checkup increased from 69.6% to 72.5% (AOR = 1.1, P < .001). The improvements in health care access were pronounced across sociodemographic groups after the ACA, especially among some disadvantaged groups (ie, young adults, non-Hispanic Blacks and Hispanics, and those with low income and low education). However, substantial disparities in health care access persisted, especially among individuals with low socioeconomic status.
Conclusions: This study identifies substantial improvements in health care access among adults with chronic health conditions after ACA implementation, especially among disadvantaged populations.
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