Problems paying medical bills and mental health symptoms post-Affordable Care Act
Problems paying medical bills and mental health symptoms post-Affordable Care Act
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DOI：
10.3934/publichealth.2020023
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发表时间：
2020-01-01
影响因子：
3.3
通讯作者：
Orban, Barbara Langland
中科院分区：
文献类型：
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作者：
Wiltshire, Jacqueline C.;Enard, Kimberly R.;Orban, Barbara Langland
医疗保健负担能力是许多美国人的担忧。我们研究支付医疗费用和心理健康问题之间的关系是否随着《平价医疗法案》（ACA）的实施而改变，该法案增加了医疗保险的覆盖面。使用了2013 - 2016年健康改革监测调查的数据，这是一项针对18-64岁美国人的调查。使用零膨胀负二项回归，调整诱发因素，使能因素和需求因素，我们检查了支付医疗费用问题（n = 85，430）的精神健康症状天数的差异。从2013年到2016年，未参保率和支付医疗费用问题率分别从15.1%下降到9.0%和22.0%下降到18.6%。有一天或一天以上的心理健康症状从39.3%增加到42.9%。报告有支付医疗费用问题的人比没有这个问题的人有更多的精神健康症状（Beta = 0.133，p < 0.001）。保险与精神健康症状的天数没有显著相关。在4年的时间里，支付医疗费用或保险状况的问题在精神健康症状的天数上没有显着差异。尽管覆盖面有所改善，但支付医疗费用问题与心理健康症状之间的关系并未改变。
Healthcare affordability is a worry for many Americans. We examine whether the relationship between having problems paying medical bills and mental health problems changed as the Affordable Care Act (ACA) was implemented, which increased health insurance coverage. Data from the 20132016 Health Reform Monitoring Survey, a survey of Americans aged 18-64, were used. Using zeroinflated negative binomial regression, adjusted for predisposing, enabling, and need factors, we examined differences in days of mental health symptoms by problems paying medical bills (n = 85,430). From 2013 to 2016, the rates of uninsured and problems paying medical bills decreased from 15.1% to 9.0% and 22.0% to 18.6%, respectively. Having one or more days of mental health symptoms increased from 39.3% to 42.9%. Individuals who reported problems paying medical bills had more days of mental health symptoms (Beta = 0.133, p < 0.001) than those who did not have this problem. Insurance was not significantly associated with days of mental health symptoms. Over the 4-year period, there were not significant differences in days of mental health symptoms by problems paying medical bills or insurance status. Despite improvements in coverage, the relationship between problems paying medical bills and mental health symptoms was not modified.