State-Level Surveillance of Underinsurance and Health Care-Related Financial Burden
State-Level Surveillance of Underinsurance and Health Care-Related Financial Burden
复制标题
DOI：
10.1097/phh.0000000000000481
复制
发表时间：
2017-09-01
影响因子：
3.3
通讯作者：
Cooper, Tara
中科院分区：
文献类型：
--
作者：
Dumont, Dora M.;Oh, Junhie;Cooper, Tara
背景资料：《平价医疗法案》（ACA）减少了不保险，但保险不足、医疗保健相关的财务负担和牙科不保险可能不会效仿。保险不足与获得医疗服务的机会减少、家庭债务和破产有关，但在没有经济数据的情况下很难跟踪。方法：我们使用现成的州一级调查数据建立一个模型，各州可以采用该模型对保险不足和医疗保健相关的财务负担进行监测，并评估相关的差异和健康状况。在ACA的个人任务的第一年，保险不足和牙科不保险的国家患病率没有改变。保险不足与较差的健康相关生活质量指标相关：与完全保险相比，保险不足的成年人的调整优势比为2.40（95%CI，1.71-3.38）一般健康状况一般或较差。跟踪保险不足和医疗债务可以帮助公共卫生和医疗保健获取利益相关者评估哪些机制（免赔额、共同支付、未覆盖的服务或按比例定价的医疗保健服务和产品）是护理和改善健康结果的障碍。
Background: The Affordable Care Act (ACA) has reduced uninsurance, but underinsurance, health care-related financial burden, and dental uninsurance may not follow suit. Underinsurance is associated with reduced access to care, household debt, and bankruptcy but has been difficult to track without economic data.Methods: We used readily available state-level survey data to build a model that states can adopt to implement surveillance over underinsurance and health care-related financial burden, as well as assess related disparities and health profiles.Results: The state prevalence of underinsurance and dental uninsurance did not change in the first year of the ACA's individual mandate. Underinsurance was associated with poorer health-related quality-of-life measures: compared with the fully insured, underinsured adults had an adjusted odds ratio of 2.40 (95% CI, 1.71-3.38) of fair or poor general health.Conclusion: Tracking underinsurance and medical debt can help public health and health care access stakeholders evaluate which mechanisms (deductibles, co-pays, uncovered services, or is proportionately priced health care services and products) are barriers to care and improved health outcomes.