The impact of Medicaid funding structures on inequities in health care access for Latinos in New York, Florida, and Puerto Rico.
The impact of Medicaid funding structures on inequities in health care access for Latinos in New York, Florida, and Puerto Rico.
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医疗补助资金结构对纽约、佛罗里达和波多黎各拉丁裔医疗保健获取不平等的影响。
DOI：
10.1111/1475-6773.14036
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发表时间：
2022
影响因子：
3.4
通讯作者：
Ortega,AlexanderN
中科院分区：
文献类型：
--
作者：
Rivera-González,AlexandraC;Roby,DylanH;Stimpson,JimP;Bustamante,ArturoVargas;Purtle,Jonathan;Bellamy,ScarlettL;Ortega,AlexanderN
目的研究《平价医疗法案》（ACA）实施前后医疗补助资金结构对纽约拉美裔人获得医疗服务的影响（医疗补助扩展），佛罗里达（医疗补助非扩展）和波多黎各（Medicaid block grant）。数据来源汇总的纽约、佛罗里达、和波多黎各的2011-2019年行为风险因素监测系统数据以及2011- 2019年2019年美国社区调查和波多黎各社区调查。研究设计使用概率单位和预测边际分别进行的横断面研究比较纽约、佛罗里达和波多黎各的拉丁美洲人的四种医疗保健获取措施（有医疗保险、有私人医生、因费用而延迟护理和有常规检查）。我们还使用差异中的差异来衡量之前拥有任何健康保险和任何公共健康保险的概率百分比变化（2011-2013年）及其后（2014-2019）ACA在低收入家庭的公民拉丁美洲人中的实施。数据收集样本包括居住在纽约、佛罗里达、和波多黎各从2011年到2019年。主要发现佛罗里达州的拉丁美洲人在所有四个指标和所有时间段内获得医疗保健的可能性最低，而纽约和波多黎各。虽然与两个州的拉丁美洲人相比，波多黎各的拉丁美洲人有更大的整体医疗保健机会，但波多黎各的医疗保健机会并没有随着时间的推移而改变。在低收入家庭的拉丁裔公民中，纽约拥有任何医疗保险和任何公共医疗保险的概率最大，与波多黎各的差距越来越大（9.7%任何[1.6 SE]，5.2%公共[1.8 SE]）。（不扩大佛罗里达的医疗补助计划）和上限医疗补助基金（波多黎各的医疗补助整笔赠款）随着时间的推移减少了医疗保健的获得，特别是对低收入家庭的拉丁美洲公民。
ObjectiveTo study the impact of Medicaid funding structures before and after the implementation of the Affordable Care Act (ACA) on health care access for Latinos in New York (Medicaid expansion), Florida (Medicaid non‐expansion), and Puerto Rico (Medicaid block grant).Data SourcesPooled state‐level data for New York, Florida, and Puerto Rico from the 2011–2019 Behavioral Risk Factor Surveillance System and data from the 2011–2019 American Community Survey and Puerto Rico Community Survey.Study DesignCross‐sectional study using probit with predicted margins to separately compare four health care access measures among Latinos in New York, Florida, and Puerto Rico (having health insurance coverage, having a personal doctor, delayed care due to cost, and having a routine checkup). We also used difference‐in‐differences to measure the probability percent change of having any health insurance and any public health insurance before (2011–2013) and after (2014–2019) the ACA implementation among citizen Latinos in low‐income households.Data CollectionThe sample consisted of Latinos aged 18–64 residing in New York, Florida, and Puerto Rico from 2011 to 2019.Principal FindingsLatinos in Florida had the lowest probability of having health care access across all four measures and all time periods compared with those in New York and Puerto Rico. While Latinos in Puerto Rico had greater overall health care access compared with Latinos in both states, health care access in Puerto Rico did not change over time. Among citizen Latinos in low‐income households, New York had the greatest post‐ACA probability of having any health insurance and any public health insurance, with a growing disparity with Puerto Rico (9.7% any [1.6 SE], 5.2% public [1.8 SE]).ConclusionsLimited Medicaid eligibility (non‐expansion of Florida's Medicaid program) and capped Medicaid funds (Puerto Rico's Medicaid block grant) contributed to reduced health care access over time, particularly for citizen Latinos in low‐income households.