Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act.
Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act.
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DOI：
10.1097/mlr.0000000000000467
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发表时间：
2016-02
期刊：
影响因子：
3
通讯作者：
Ortega AN
中科院分区：
文献类型：
--
作者：
Chen J;Vargas-Bustamante A;Mortensen K;Ortega AN
为了调查 2014 年《平价医疗法案》(ACA) 医疗保险强制令全面实施后，医疗保健获取和利用方面的种族和民族差异。我们利用 2011-2014 年全国健康访谈调查，研究了美国非老年成年人口在医疗保健获取和利用方面的变化。估计多元线性概率模型以适应人口和社会人口因素。 ACA（年份指标 2014）的实施与未投保的概率显着降低（coef=-0.03，P<0.001）、延迟任何必要护理（coef=-0.03，P<0.001）、放弃任何必要护理（coef=-0.02，P<0.001）以及就诊概率显着增加相关。 （coef=0.02，P<0.001），与 2011 年参考年相比。2014 年指标与种族/族裔之间的交互作用表明，与非拉丁裔美国人相比，非拉丁裔非洲裔美国人（非裔美国人）（coef=-0.04，P<0.001）和拉丁裔美国人（coef=-0.03，P<0.001）的未参保率下降幅度更大白人（白人）。与白人相比，拉丁裔在 2014 年推迟（coef=−0.02，P<0.001）或放弃（coef=−0.02，P<0.001）任何必要护理的可能性较小，并且更有可能去看医生（coef=0.03，P<0.005）。2014 年年份指标与急诊科就诊概率之间的关联并不显着。在 ACA 实施之前，医疗保健获取和保险覆盖范围是造成种族和民族差异的主要因素。我们的研究结果表明，在《平价医疗法案》实施的最初几年中，种族和民族差异已显着减少，该法案扩大了医疗保险的覆盖范围并强制个人获得医疗保险。
To examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014. Using the 2011–2014 National Health Interview Survey, we examine changes in health care access and utilization for the nonelderly US adult population. Multivariate linear probability models are estimated to adjust for demographic and sociodemographic factors. The implementation of the ACA (year indicator 2014) is associated with significant reductions in the probabilities of being uninsured (coef=−0.03, P<0.001), delaying any necessary care (coef=−0.03, P<0.001), forgoing any necessary care (coef=−0.02, P<0.001), and a significant increase in the probability of having any physician visits (coef=0.02, P<0.001), compared with the reference year 2011. Interaction terms between the 2014 year indicator and race/ethnicity demonstrate that uninsured rates decreased more substantially among non-Latino African Americans (African Americans) (coef=−0.04, P<0.001) and Latinos (coef=−0.03, P<0.001) compared with non-Latino whites (whites). Latinos were less likely than whites to delay (coef=−0.02, P<0.001) or forgo (coef=−0.02, P<0.001) any necessary care and were more likely to have physician visits (coef=0.03, P<0.005) in 2014. The association between year indicator of 2014 and the probability of having any emergency department visits is not significant. Health care access and insurance coverage are major factors that contributed to racial and ethnic disparities before the ACA implementation. Our results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health insurance.