Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act
Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act
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DOI：
10.3122/jabfm.2019.06.190087
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发表时间：
2019-11-01
影响因子：
2.9
通讯作者：
DeVoe, Jennifer E.
中科院分区：
文献类型：
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作者：
Huguet, Nathalie;Angier, Heather;DeVoe, Jennifer E.
目的：为了评估社区卫生中心（CHC）患者获得保险后负担得起的医疗法案（ACA）的患病率，我们分析了来自19个州的386个CHC的78，059名年龄在19至64岁之间的患者的电子健康记录数据，这些患者在ACA前的最后一次访问时没有保险。我们比较了ACA前（2012年至2013年）和ACA后（2014年至2015年）的患病率和预先存在的疾病类型，按保险状况和种族/ethnication.Results：ACA前，队列中>50%的患者有>= 1的预先存在的疾病。ACA后，>70%获得保险的人患有>= 1种疾病。ACA后，所有人种/种族亚组的既存疾病数量均增加，非西班牙裔黑人和西班牙裔患者的增加幅度最大（校正后的患病率差异分别为18.9; 95% CI，18.2 - 19.6和18.3; 95% CI，17.8 - 18.7）。ACA后最常见的条件是心理健康障碍，获得医疗补助（45.6%）的患者中患病率最高，而获得私人保险的患者中患病率最低（30.5%）。结论：本研究强调了CHC患者中预先存在的条件的高患病率，以及ACA后至少有1种诊断的患者比例的大幅增加。考虑到这些情况的普遍性，废除预先存在的条件保护可能对数百万患者造成极大伤害，并可能加剧医疗保健和健康差距。
Objective: To assess the prevalence of pre-existing conditions for community health center (CHC) patients who gained insurance coverage post-Affordable Care Act (ACA).Methods: We analyzed electronic health record data from 78,059 patients aged 19 to 64 uninsured at their last visit pre-ACA from 386 CHCs in 19 states. We compared the prevalence and types of pre-existing conditions pre-ACA (2012 to 2013) and post-ACA (2014 to 2015), by insurance status and race/ethnicity.Results: Pre-ACA, >50% of patients in the cohort had >= 1 Pre-existing condition. Post-ACA, >70% of those who gained insurance coverage had >= 1 condition. Post-ACA, all racial/ethnic subgroups showed an increase in the number of pre-existing conditions, with non-Hispanic Black and Hispanic patients experiencing the largest increases (adjusted prevalence difference, 18.9; 95% CI, 18.2 to 19.6 and 18.3; 95% CI, 17.8 to 18.7, respectively). The most common conditions post-ACA were mental health disorders with the highest prevalence among patients who gained Medicaid (45.6%) and lowest among those who gained private coverage (30.5%).Conclusions: This study emphasizes the high prevalence of pre-existing conditions among CHC patients and the large increase in the proportion of patients with at least 1 of these diagnoses post-ACA. Given how common these conditions are, repealing pre-existing condition protections could be extremely harmful to millions of patients and would likely exacerbate health care and health disparities.