Insurance Coverage and Utilization Improve for Latino Youth but Disparities by Heritage Group Persist Following the ACA
Insurance Coverage and Utilization Improve for Latino Youth but Disparities by Heritage Group Persist Following the ACA
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DOI：
10.1097/mlr.0000000000000992
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发表时间：
2018-11-01
期刊：
影响因子：
3
通讯作者：
Ortega, Alexander N.
中科院分区：
文献类型：
--
作者：
Pintor, Jessie Kemmick;Chen, Jie;Ortega, Alexander N.
目标：与非拉丁裔白色青年相比，拉丁裔青年获得和利用医疗保健的情况更差，在《平价医疗法案》（ACA）实施后，不公平现象持续存在。为了更好地了解这些差异，我们研究了青年的访问和利用与ACA不同的拉丁裔遗产组相对于white.Study设计的变化：我们使用6年（2011-2016）的国家健康访谈调查数据，研究拉丁裔青年的保险范围和医疗保健利用遗产组，出生，和父母的语言。使用的依赖性措施包括良好的儿童，急诊室，和医生的访问。我们使用多变量逻辑回归模型来估计每个依赖措施和相互作用的遗产组和时间段[2011-2013年（前ACA）与2014-2016年（后ACA）]的几率，以检查与ACA相关的变化如何随组而变化。虽然墨西哥和中美洲或南美洲的年轻人经历了最大的绝对增长覆盖率，他们仍然有很高的水平不保险后ACA（9.9%和9.1%，分别）。波多黎各青年和白色青年之间的覆盖率差距有所改善，而墨西哥青年和白色青年之间的健康儿童就诊率差距则有所扩大。几乎没有运动观察到的差距出生和父母language.Conclusions：大多数的差距，在保险和利用整个拉丁美洲遗产群体和白色青年坚持后ACA，尽管组内的显着收益。虽然波多黎各青年的差距有所改善，但墨西哥和中美洲或南美洲青年继续经历差距。
Objective:Latino youth experience worse access to and utilization of health care compared with non-Latino white youth, with inequities persisting following the implementation of the Affordable Care Act (ACA). To better understand these disparities, we examine changes in youth's access and utilization associated with the ACA for different Latino heritage groups relative to whites.Study Design:We use 6 years (2011-2016) of National Health Interview Survey data to examine Latino youth's insurance coverage and health care utilization by heritage group, nativity, and parental language. The dependent measures of utilization included well-child, emergency department, and physician visits. We used multivariable logistic regression models to estimate the odds of each dependent measure and interacted heritage group and time period [2011-2013 (pre-ACA) versus 2014-2016 (post-ACA)] to examine how changes associated with the ACA varied by group.Results:Insurance coverage and well-child visits improved among youth overall following implementation of the ACA. Although Mexican and Central or South American youth experienced the largest absolute increase in coverage, they still had high levels of uninsurance post-ACA (9.9% and 9.1%, respectively). Disparities in coverage between Puerto Rican and white youth improved, while disparities in well-child visits between Mexican and white youth worsened. Little to no movement was observed in disparities by nativity and parental language.Conclusions:Most disparities in insurance and utilization across Latino heritage groups and white youth persisted post-ACA despite significant gains within groups. Although disparities for Puerto Rican youth have improved, Mexican and Central or South American youth continue to experience disparities.