Treatment use, sources of payment, and financial barriers to treatment among individuals with opioid use disorder following the national implementation of the ACA
Treatment use, sources of payment, and financial barriers to treatment among individuals with opioid use disorder following the national implementation of the ACA
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DOI：
10.1016/j.drugalcdep.2017.06.028
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发表时间：
2017-10-01
影响因子：
4.2
通讯作者：
McKenna, Ryan M.
中科院分区：
文献类型：
--
作者：
McKenna, Ryan M.
简介：尽管阿片类药物滥用和住院率不断增加，但阿片类药物使用障碍 (OUD) 患者的治疗率非常低。本研究探讨了《患者保护和平价医疗法案》(ACA) 保险范围的扩大对提高 OUD 患者的保险率、医疗保健获取率和治疗率的影响。方法：18-64 岁 OUD 患者的数据来自 2008-2014 年全国药物使用和健康调查 (N = 4100)。通过多变量逻辑回归分析来估计 ACA 实施各个阶段的医疗保险、治疗和护理障碍的趋势：ACA 实施前（2008-2009 年）、部分 ACA（2010-2013 年）和国家实施（2014 年）。所有模型均针对诱发因素、促成因素和需求因素进行了调整。结果：在调整后和未调整的比较中，国家实施 ACA 与 OUD 患者结果指标的显着改善相关。多变量分析表明，在国家实施后，与 ACA 之前相比，那些拥有 OUD 的人没有保险的可能性显着降低，并且不太可能将财务障碍报告为不接受药物滥用治疗的原因。与平价医疗法案之前相比，在国家实施平价医疗法案之后，个人更有可能接受药物滥用治疗，并且更有可能报告保险支付治疗费用。当将国家实施情况与部分实施情况进行比较时，这些结果仍然存在。结论：ACA 的国家实施有助于降低无保险率、护理障碍，并提高 OUD 患者的药物滥用治疗率。
Introduction: Despite increasing rates of opioid misuse and hospitalizations, rates of treatment for those with opioid use disorder (OUD) are very low. This study examined the impact of the Patient Protection and Affordable Care Act's (ACA) insurance expansion on improving rates of insurance, health care access, and treatment for those with OUD.Methods: Data on individuals ages 18-64 with OUD come from the 2008-2014 National Survey on Drug Use and Health (N = 4100). Multivariable logistic regression analyses were performed to estimate the trends of health care insurance, treatment and barriers to care across the stages of ACA implementation: pre-ACA (2008-2009), partial-ACA (2010-2013), and national implementation (2014). All models were adjusted for predisposing, enabling, and need factors.Results: In both adjusted and unadjusted comparisons, national implementation of the ACA was associated with significant improvements in outcome measures for those with OUD. Multivariable analyses indicate that, after national implementation, those with OUD were significantly less likely to be uninsured and were less likely to report financial barriers as a reason for not receiving substance use treatment, relative to the pre-ACA period. Individuals were also more likely to receive substance use treatment and were more likely to report that insurance paid for treatment after national implementation of the ACA relative to the pre-ACA period. These results persisted when national implementation was compared relative to partial-implementation.Conclusions: National implementation of the ACA has helped to reduce rates of uninsurance, barriers to care, and improve rates of substance use treatment for those with OUD.