The Effects of the Affordable Care Act on Health Care Access and Utilization Among Asian American Subgroups
The Effects of the Affordable Care Act on Health Care Access and Utilization Among Asian American Subgroups
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DOI：
10.1097/mlr.0000000000001202
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发表时间：
2019-11-01
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：
Park, Sungchul;Stimpson, Jim P.;Ortega, Alexander N.
目的：我们研究了不同亚裔美国人亚组相对于非拉丁裔白人（白人）与患者保护和平价医疗法案（ACA）相关的医疗服务获得和利用的变化。研究设计：使用2003-2017年加州健康访谈调查数据，我们检查了白人和7个亚裔美国人亚组中4项医疗保健获取措施和2项利用措施的变化。我们估计了从ACA前到ACA后时期的绝对规模上的未调整和调整的百分点变化。调整后的估计值是从多变量逻辑回归模型中获得的，该模型控制了易感因素、使能因素和需求因素。我们还估计了前ACA后ACA白人和亚裔美国人亚组之间的变化，使用差异中的差异的方法。结果如下：ACA实施后，所有亚裔美国人亚组的不保险减少，但在这些措施中相对于白人的差距改善有限。特别是，韩国人在无保险方面的绝对下降幅度最大（-16.8个百分点），并且是唯一一个相对于白人差距显著缩小的亚组（-10.1个百分点）。然而，在其他3项获取措施（有常规护理来源、过去一年延迟医疗护理或过去一年延迟处方药使用）和2项利用措施（过去一年有医生就诊或急诊室就诊）中观察到很少或没有改善。结论：尽管亚裔美国人亚组，特别是韩国人的覆盖率有所提高，但在所有亚裔美国人亚组中，获得和利用的差距仍然存在。
Objectives: We examined changes in health care access and utilization associated with the Patient Protection and Affordable Care Act (ACA) for different Asian American subgroups relative to non-Latino whites (whites). Research Design: Using 2003-2017 California Health Interview Survey data, we examined changes in 4 health care access measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. Results: After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (-16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (-10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). Conclusions: Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.