How Might the Affordable Care Act's Coverage Expansion Provisions Influence Demand for Medical Care?
How Might the Affordable Care Act's Coverage Expansion Provisions Influence Demand for Medical Care?
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DOI：
10.1111/1468-0009.12041
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发表时间：
2014-03-01
影响因子：
6.6
通讯作者：
Abraham, Jean Marie
中科院分区：
文献类型：
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作者：
Abraham, Jean Marie
《平价医疗法案》(ACA)预计将把医疗保险扩大到2500万人。由于保险降低了医疗价格，预计这些新覆盖的个人的服务需求数量将会上升。在这篇文章中，我提供了ACA扩大覆盖范围的目标人群的人口统计、健康状况和医疗保健利用的综合图景，并与其他非老年、有保险的人群进行了对比。此外，我还大量参考了来自马萨诸塞州和俄勒冈州的最新证据，综合了当前关于保险对医疗需求的因果影响的证据。方法利用2008至2010年的医疗支出小组调查，我进行了双变量和多变量分析，以检验ACA目标人群与其他参保群体的差异。我使用描述性分析和准实验文献的结果，对覆盖范围扩大对非制度化美国人口的总医疗保健利用的潜在影响进行了粗略的估计。发现潜在的ACA目标人群与私人和公共保险的比较显示，前者更年轻，更有可能是男性。ACA的目标人群，特别是收入低于联邦贫困线200%的未参保人群，报告称，与私人和公共参保人群相比，几种疾病的发病率较低。根据描述性发现和准实验文献的推论，新参保者的住院住院率和急诊室使用率的未来变化可能会有很大差异。结果还表明，门诊护理适度增加。新参保者对医疗服务总体需求的增加在总使用率中所占比例不大。结论随着覆盖面扩大导致使用率的预期增加，利益相关者将需要监测当地医疗保健提供系统的能力，并在需要时以政策和/或市场为基础的创新做出反应。
ContextThe Affordable Care Act (ACA) is predicted to expand health insurance to 25 million individuals. Since insurance reduces the price of medical care, the quantity of services demanded by these newly covered individuals is expected to rise. In this article I provide a comprehensive picture of the demographics, health status, and medical care utilization of the population targeted for the ACA's expansion of coverage, contrasted with that of other nonelderly, insured populations. In addition, I synthesize the current evidence regarding the causal impact of insurance on medical care demand, drawing heavily on recent evidence from Massachusetts and Oregon.MethodsUsing the 2008 to 2010 Medical Expenditure Panel Survey, I conducted bivariate and multivariate analyses to examine differences between the ACA target population and other insured groups. I used the results from the descriptive analysis and quasi-experimental literature to generate back of the envelope estimates of the potential impact of the coverage expansion on total medical care utilization by the noninstitutionalized US population.FindingsComparisons of the potential ACA target population with the privately and publicly insured reveal that the former is younger and more likely to be male. The ACA target population, and particularly the uninsured with incomes under 200% of the federal poverty line, reports lower rates of several medical conditions relative to those of the privately and publicly insured. Future changes in rates of inpatient hospitalization and ED use among the newly insured could vary widely, based on descriptive findings and inferences from the quasi-experimental literature. Results also suggest moderate increases in ambulatory care. Total increases in overall demand for medical care by the newly insured comprise a modest proportion of the aggregate utilization.ConclusionsWith the expected increases in utilization resulting from the coverage expansion, stakeholders will need to monitor local health care delivery system capacity and respond where needed with policy- and/or market-based innovations.