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Assessing the Effect of the ACA and State Policies on Racial/Ethnic, Sex, and Insurance-Based Disparities

评估《平价医疗法案》和州政策对种族/民族、性别和基于保险的差异的影响

基本信息

批准号：
8994511
负责人：
Rajiv Sharma
金额：
$ 43.49万
依托单位：
PORTLAND STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-22 至 2018-06-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Analysis of state and national policies that affect racial/ethnic disparities in healthcare is a research topic of specific interest for the NIMHD, and simulated consumer (audit) studies have emerged as an important methodology for measuring disparities and assessing the effects of public and private policies on disparities. By experimentally controlling for consumer characteristics, such studies avoid the responder biases associated with surveys and the limitations of utilization analyses (e.g., controlling for differences in health and treatment preferences). The Longitudinal Access to Physicians Study (LAPS) in this proposal is innovative because it is the first to audit the effects of race/ethnicit and sex on access, to audit a national random sample of primary care physicians, and to audit access for Medicare patients. In LAPS, student research assistants (SRAs) call the offices of primary care physicians to request appointment information for a purported uncle or aunt. Each physician is randomly assigned a male or female patient profile with an insurance type and a name signaling race/ethnicity. The central hypotheses underlying this proposal are: a) Increases in the demand for physician services due to the Affordable Care Act's (ACA) major insurance expansion will initially decrease appointment availability, but that appointment availability will improve over time as the health care system adjusts to the insurance expansion; b) The decrease in appointment availability will be smaller in states that experience smaller insurance expansions and have more generous physician reimbursement policies; and c) Changes in access will be differ for population subgroups leading to changes in disparities in access. These hypotheses will be tested by pursuing two specific aims: 1) Measuring changes in 2014, 2015, and 2016 from ACA- baseline in appointment availability and in disparities in appointment availability; and 2) Measuring changes in 2014, 2015, and 2016 from ACA-baseline in appointment availability and in disparities in appointment availability in states with different Medicaid expansion and reimbursement policies. The proposed research is significant because the results of the study are expected to provide strong evidence of the effects of the ACA as well as insurance and reimbursement-related state policies on disparities in access to primary care physicians. This research is relevant to the goals of the NIMHD because its results are expected to enable policymakers to better identify factors contributing to disparities and design effective policies for their amelioration. This study will also fulfill the goal of research enhancement by strengthening the research environment at Portland State University, the largest and most diverse university in Oregon. All SRAs learn the importance of ethics, human subjects' protections, and consistency in research. Some SRAs also learn about study design, statistical methods, and the broader literature on disparities. This study will create opportunitie for greater student participation and interest in disparities research.

描述（由申请人提供）：对影响医疗保健中种族/民族差异的州和国家政策的分析是NIMHD特别感兴趣的研究课题，模拟消费者（审计）研究已成为衡量差距和评估公共和私人政策对差距的影响的重要方法。通过实验控制消费者特征，这些研究避免了与调查相关的响应者偏差和利用分析的局限性（例如，控制健康和治疗偏好的差异）。该提案中的纵向医生访问研究（LAPS）是创新的，因为它是第一个审计种族/民族和性别对访问的影响，审计全国随机抽样的初级保健医生，并审计医疗保险患者的访问。在LAPS中，学生研究助理（SRA）打电话给初级保健医生的办公室，要求提供所谓的叔叔或阿姨的预约信息。每名医生都被随机分配了一名男性或女性患者的资料，其中包括保险类型和表明种族/民族的姓名。这项建议的核心假设是：a）由于《平价医疗法案》（ACA）的主要保险扩张，对医生服务的需求增加，最初将减少预约的可用性，但随着医疗保健系统适应保险扩张，预约的可用性将随着时间的推移而改善; B）在保险扩张较小且医生报销政策更慷慨的州，预约可用性的下降幅度较小;（c）各人口分组在获得服务方面的变化将有所不同，从而导致获得服务方面的差距有所变化。这些假设将通过追求两个具体目标进行测试：1）测量2014年，2015年和2016年ACA的变化-任命可用性和任命可用性差异的基线;（2）衡量2014年、2015年的变化，2016年，由A.C.预约可用性的基线以及具有不同医疗补助扩展和报销政策的州的预约可用性的差异。拟议的研究是重要的，因为该研究的结果预计将提供有力的证据，ACA以及保险和报销相关的国家政策对获得初级保健医生的差距的影响。这项研究是相关的目标，国家机制，因为其结果预计将使决策者能够更好地确定因素造成的差距，并设计有效的政策，改善。这项研究还将通过加强俄勒冈州最大，最多样化的大学波特兰州立大学的研究环境来实现研究增强的目标。所有SRA都了解伦理、人类受试者保护和研究一致性的重要性。一些SRA还学习研究设计，统计方法和更广泛的关于差异的文献。这项研究将创造机会，更大的学生参与和差异研究的兴趣。