Following Uninsured Patients Through Medicaid Expansion: Ambulatory Care Use and Diagnosed Conditions.
Ann Fam Med
; 17(4): 336-344, 2019 07.
Article
em En
| MEDLINE
| ID: mdl-31285211
ABSTRACT
PURPOSE:
The Patient Protection and Affordable Care Act (ACA) has improved access to health insurance, yet millions remain uninsured. Many patients who remain uninsured access care at community health centers (CHCs); however, little is known about their health conditions and health care use. We assessed ambulatory care use and diagnosed health conditions among a cohort of CHC patients uninsured before enactment of the ACA (pre-ACA January 1, 2012 to December 31, 2013) and followed them after enactment (post-ACA January 1, 2014 to December 31, 2015).METHODS:
This retrospective cohort analysis used electronic health record data from CHCs in 11 US states that expanded Medicaid eligibility. We assessed ambulatory care visits and documented health conditions among a cohort of 138,246 patients (aged 19 to 64 years) who were uninsured pre-ACA and either remained uninsured, gained Medicaid, gained other health insurance, or did not have a visit post-ACA. We estimated adjusted predicted probabilities of ambulatory care use using an ordinal logistic mixed-effects regression model.RESULTS:
Post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The majority of patients had ≥1 diagnosed health condition. The adjusted proportion of patients with high use (≥6 visits over 2 years) increased from pre-ACA to post-ACA among those who gained Medicaid (pre-ACA 23%, post-ACA 34%, P <.001) or gained other insurance (pre-ACA 29%, post-ACA 48%, P <.001), whereas the percentage fell slightly for those continuously uninsured.CONCLUSIONS:
A significant percentage of CHC patients remained uninsured; many who remained uninsured had diagnosed health conditions, and one-half continued to have ≥3 visits to CHCs. CHCs continue to be essential providers for uninsured patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Medicaid
/
Pessoas sem Cobertura de Seguro de Saúde
/
Centros Comunitários de Saúde
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Patient Protection and Affordable Care Act
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Ann Fam Med
Assunto da revista:
MEDICINA DE FAMILIA E COMUNIDADE
Ano de publicação:
2019
Tipo de documento:
Article