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

 描述(由申请人提供)：对影响医疗保健中种族/民族差异的国家和国家政策的分析是NIMHD特别感兴趣的研究主题，以及 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。通过对消费者特征进行实验控制，这些研究避免了与调查相关的应答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)。这项提案中的医生纵向准入研究(LAPS)具有创新性，因为它是第一次审计种族/民族和性别对准入的影响，审计全国随机抽样的初级保健医生，以及审计联邦医疗保险患者的准入。在LAPS中，学生研究助理(SRAS)打电话给初级保健医生的办公室，要求提供据称是叔叔或阿姨的预约信息。每个医生都被随机分配了一个男性或女性患者档案，上面有一个保险类型和一个表明种族/民族的名字。这项提议背后的核心假设是：a)由于《平价医疗法案》(ACA)的重大保险扩大，对医生服务的需求增加，最初将减少预约的可获得性，但随着医疗保健系统适应保险的扩大，预约的可获得性将随着时间的推移而改善；b)在经历较小保险扩张和拥有更慷慨的医生报销政策的州，预约可获得性的减少将较小；以及c)人口亚群在获得机会方面的变化将有所不同，从而导致获得机会的差异发生变化。将通过追求两个具体目标来检验这些假设：1)衡量2014、2015和2016年与ACA相比的变化-预约可获得性基线和预约可获得性差异；以及2)衡量2014、2015和2016年ACA-在不同医疗补助扩大和报销政策的州的预约可获得性基线和预约可获得性差异的变化。这项拟议的研究意义重大，因为这项研究的结果预计将提供强有力的证据，证明ACA以及与保险和报销相关的国家政策对初级保健医生获得机会方面的差异的影响。这项研究与NIMHD的目标相关，因为预计其结果将使决策者能够更好地确定造成差距的因素，并为改善差距设计有效的政策。这项研究还将通过加强波特兰州立大学的研究环境来实现加强研究的目标，波特兰州立大学是俄勒冈州最大和最多样化的大学。所有的研究人员协会都认识到伦理道德、人类受试者的保护和研究的一致性的重要性。一些SRA还学习研究设计、统计方法和有关差异的更广泛的文献。这项研究将为更多的学生参与和对差异研究产生兴趣创造机会。

 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.