Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minority Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008⁻2015.
Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minority Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008⁻2015.
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DOI：
10.3390/ijerph15091860
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发表时间：
2018-08-28
影响因子：
--
通讯作者：
Osmani AR
中科院分区：
文献类型：
--
作者：
White-Means SI;Osmani AR
乳腺癌是美国最常见的女性癌症。白人和黑人妇女的发病率相似，但黑人妇女的死亡率更高。本研究利用了丰富的、具有全国代表性的数据，即2008-2015年医疗支出小组调查，来估计《平价医疗法案》（ACA）在减少黑人和西班牙裔乳腺癌幸存者在使用诊断和医疗服务方面的差距和获取方面的影响。采用随机效应、多项logit、灵活跨栏和Box-Cox估计技术。强有力的估计表明，ACA缩小了乳腺癌幸存者在医疗保险覆盖范围、医疗保健利用和自费处方药支出方面的种族/民族差距。黑人和西班牙裔幸存者的无保险差距显著下降。西班牙裔女性和黑人乳腺癌幸存者普遍增加了aca后乳房x光检查服务的使用。ACA并没有显著影响西班牙裔幸存者在医生使用或自付处方药支出方面的差异，而黑人乳腺癌幸存者则有实质性的改善。本文最后讨论了ACA在减少差距和改善美国不断增长的乳腺癌幸存者的健康结果方面的优势和局限性。
Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008–2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance coverage, health care utilization and out-of-pocket prescription drug expenditures among breast cancer survivors. Gaps in uninsurance significantly declined for black and Hispanic survivors. Hispanic women generally and black breast cancer survivors specifically increased use of mammography services post-ACA. The ACA did not significantly impact disparities in physician utilization or out-of-pocket prescription drug expenditures for Hispanic survivors, while there were substantive improvements for black breast cancer survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.
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影响因子：
2.3
作者：
Ansell, David;Grabler, Paula;Marcus, Elizabeth
通讯作者：
Marcus, Elizabeth
影响因子：
3.4
作者：
French, Michael T.;Homer, Jenny;Hickling, Lucas
通讯作者：
Hickling, Lucas
影响因子：
254.7
作者：
DeSantis, Carol E.;Fedewa, Stacey A.;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin
影响因子：
12.8
作者：
Alem, Yonas;Beyene, Abebe D.;Mekonnen, Alemu
通讯作者：
Mekonnen, Alemu
影响因子：
2.1
作者：
Farbmacher, Helmut
通讯作者：
Farbmacher, Helmut