Barriers to Care in an Ethnically Diverse Publicly Insured Population Is Health Care Reform Enough?
Barriers to Care in an Ethnically Diverse Publicly Insured Population Is Health Care Reform Enough?
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DOI：
10.1097/mlr.0000000000000172
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发表时间：
2014-08-01
期刊：
影响因子：
3
通讯作者：
Shippee, Tetyana
中科院分区：
文献类型：
--
作者：
Call, Kathleen T.;McAlpine, Donna D.;Shippee, Tetyana
背景资料：《平价医疗法案》规定扩大医疗补助，这可能导致多达1600万人获得医疗保险。然而，目前还不清楚这种覆盖范围的扩大将在多大程度上有意义地增加获得医疗保健的机会。目的：这项研究的目的是确定即使在个人被转移到保险后可能仍然存在的障碍，并探讨获得医疗保健服务问题的种族/民族差异。研究设计：数据来自2008年的一项跨部门混合模式调查（用4种语言进行邮件和电话随访），该调查在衡量一整套障碍和重点关注几个选定的未充分研究的族裔群体方面是独一无二的。我们研究了种族/民族的差异，在成本和覆盖面，访问和提供者相关的障碍。研究坚持以社区为基础的参与性研究过程。主题：调查是从分层随机抽样的成年人参加明尼苏达州卫生保健计划谁自我报告的种族为白色，非洲裔美国人，美国印第安人，西班牙裔，苗族，或索马里（n = 1731）。结果：所有登记者均报告在获得所需护理方面存在障碍;来自少数民族文化群体（特别是苗族和美洲印第安人）的入学者比白人更容易遇到问题。与成本和覆盖范围相关的障碍是最普遍的，72%的注册者报告了1个或多个这些问题。大约63%的入组者报告了1个或多个访问障碍。与供应商有关的障碍最不普遍（约29%），但却揭示了最普遍的差异。结论：公共保险的成年人，特别是少数种族和民族群体，在护理方面仍然存在许多挑战。ACA扩大医疗补助计划，虽然必要，但不足以实现改善和公平获得护理。
Background: The Affordable Care Act provides for the expansion of Medicaid, which may result in as many as 16 million people gaining health insurance coverage. Yet it is unclear to what extent this coverage expansion will meaningfully increase access to health care.Objective: The objective of the study was to identify barriers that may persist even after individuals are moved to insurance and to explore racial/ethnic variation in problems accessing health care services.Research Design: Data are from a 2008 cross-sectional mixed-mode survey (mail with telephone follow-up in 4 languages), which is unique in measuring a comprehensive set of barriers and in focusing on several select understudied ethnic groups. We examine racial/ethnic variation in cost and coverage, access, and provider-related barriers. The study adhered to a community-based participatory research process.Subjects: Surveys were obtained from a stratified random sample of adults enrolled in Minnesota Health Care Programs who self-report ethnicity as white, African American, American Indian, Hispanic, Hmong, or Somali (n = 1731).Results: All enrollees reported barriers to getting needed care; enrollees from minority cultural groups (Hmong and American Indian in particular) were more likely to experience problems than whites. Barriers associated with cost and coverage were the most prevalent, with 72% of enrollees reporting 1 or more of these problems. Approximately 63% of enrollees reported 1 or more access barriers. Provider-related barriers were the least prevalent (about 29%) yet revealed the most pervasive disparities. Conclusions: Many challenges to care persist for publicly insured adults, particularly minority racial and ethnic groups. The ACA expansion of Medicaid, although necessary, is not sufficient for achieving improved and equitable access to care.