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3.
PLoS Med ; 17(5): e1003119, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32421717

RESUMEN

BACKGROUND: Criminal justice involvement is common among pregnant women with opioid use disorder (OUD). Medications for OUD improve pregnancy-related outcomes, but trends in treatment data among justice-involved pregnant women are limited. We sought to examine trends in medications for OUD among pregnant women referred to treatment by criminal justice agencies and other sources before and after the Affordable Care Act's Medicaid expansion. METHODS AND FINDINGS: We conducted a serial, cross-sectional analysis using 1992-2017 data from pregnant women admitted to treatment facilities for OUD using a national survey of substance use treatment facilities in the United States (N = 131,838). We used multiple logistic regression and difference-in-differences methods to assess trends in medications for OUD by referral source. Women in the sample were predominantly aged 18-29 (63.3%), white non-Hispanic, high school graduates, and not employed. Over the study period, 26.3% (95% CI 25.7-27.0) of pregnant women referred by criminal justice agencies received medications for OUD, which was significantly less than those with individual referrals (adjusted rate ratio [ARR] 0.45, 95% CI 0.43-0.46; P < 0.001) or those referred from other sources (ARR 0.51, 95% CI 0.50-0.53; P < 0.001). Among pregnant women referred by criminal justice agencies, receipt of medications for OUD increased significantly more in states that expanded Medicaid (n = 32) compared with nonexpansion states (n = 18) (adjusted difference-in-differences: 12.0 percentage points, 95% CI 1.0-23.0; P = 0.03). Limitations of this study include encounters that are at treatment centers only and that do not encompass buprenorphine prescribed in ambulatory care settings, prisons, or jails. CONCLUSIONS: Pregnant women with OUD referred by criminal justice agencies received evidence-based treatment at lower rates than women referred through other sources. Improving access to medications for OUD for pregnant women referred by criminal justice agencies could provide public health benefits to mothers, infants, and communities. Medicaid expansion is a potential mechanism for expanding access to evidence-based treatment for pregnant women in the US.


Asunto(s)
Medicina Basada en la Evidencia/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/terapia , Adulto , Femenino , Hispanoamericanos , Humanos , Patient Protection and Affordable Care Act , Embarazo , Estudios Retrospectivos , Estados Unidos , Adulto Joven
6.
Med Care ; 58(6): 497-503, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32412941

RESUMEN

BACKGROUND: Rates of low birthweight and prematurity vary 2-fold across states in the United States, with increased rates among states with higher concentrations of racial minorities. Medicaid expansion may serve as a mechanism to reduce geographic variation within states that expanded, by improving health and access to care for vulnerable populations. OBJECTIVE: The objective of this study was to identify the association of Medicaid expansion with changes in county-level geographic variation in rates of low birthweight and preterm births, overall and stratified by race/ethnicity. RESEARCH DESIGN: We compared changes in the coefficient of variation and the ratio of the 80th-to-20th percentiles using bootstrap samples (n=1000) of counties drawn separately for all births and for white, black, and Hispanic births, separately. MEASURES: County-level rates of low birthweight and preterm birth. RESULTS: Before Medicaid expansion, counties in expansion states were concentrated among quintiles with lower rates of adverse birth outcomes and counties in nonexpansion states were concentrated among quintiles with higher rates. In expansion states, county-level variation, measured by the coefficient of variation, declined for both outcomes among all racial/ethnic categories. In nonexpansion states, geographic variation reduced for both outcomes among Hispanic births and for low birthweight among white births, but increased for both outcomes among black births. CONCLUSIONS: The decrease in county-level variation in adverse birth outcomes among expansion states suggests improved equity in these states. Further reduction in geographic variation will depend largely on policies or interventions that reduce racial disparities in states that did and did not expand Medicaid.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Recién Nacido de Bajo Peso , Medicaid/estadística & datos numéricos , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Nacimiento Prematuro/etnología , Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Encuestas Epidemiológicas , Hispanoamericanos/estadística & datos numéricos , Humanos , Recién Nacido , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Análisis Espacial , Estados Unidos/epidemiología
7.
Med Care ; 58 Suppl 6 Suppl 1: S31-S39, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32412951

RESUMEN

BACKGROUND: Racial and ethnic minorities are disproportionately affected by diabetes and at greater risk of experiencing poor diabetes-related outcomes compared with non-Hispanic whites. The Affordable Care Act (ACA) was implemented to increase health insurance coverage and reduce health disparities. OBJECTIVE: Assess changes in diabetes-associated biomarkers [hemoglobin A1c (HbA1c) and low-density lipoprotein] 24 months pre-ACA to 24 months post-ACA Medicaid expansion by race/ethnicity and insurance group. RESEARCH DESIGN: Retrospective cohort study of community health center (CHC) patients. SUBJECTS: Patients aged 19-64 with diabetes living in 1 of 10 Medicaid expansion states with ≥1 CHC visit and ≥1 HbA1c measurement in both the pre-ACA and the post-ACA time periods (N=13,342). METHODS: Linear mixed effects and Cox regression modeled outcome measures. RESULTS: Overall, 33.5% of patients were non-Hispanic white, 51.2% Hispanic, and 15.3% non-Hispanic black. Newly insured Hispanics and non-Hispanic whites post-ACA exhibited modest reductions in HbA1c levels, similar benefit was not observed among non-Hispanic black patients. The largest reduction was among newly insured Hispanics versus newly insured non-Hispanic whites (P<0.05). For the subset of patients who had uncontrolled HbA1c (HbA1c≥9%) within 3 months of the ACA Medicaid expansion, non-Hispanic black patients who were newly insured gained the highest rate of controlled HbA1c (hazard ratio=2.27; 95% confidence interval, 1.10-4.66) relative to the continuously insured group. CONCLUSIONS: The impact of the ACA Medicaid expansion on health disparities is multifaceted and may differ across racial/ethnic groups. This study highlights the importance of CHCs for the health of minority populations.


Asunto(s)
Diabetes Mellitus/sangre , Disparidades en el Estado de Salud , Patient Protection and Affordable Care Act , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Biomarcadores/sangre , Niño , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hemoglobina A Glucada/análisis , Hispanoamericanos/estadística & datos numéricos , Humanos , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos , Adulto Joven
8.
PLoS One ; 15(4): e0231417, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32271845

RESUMEN

OBJECTIVE: Evaluate how the use of a Section 1115 waiver in Arkansas was associated with health insurance coverage compared to Medicaid expansion states that did not use a waiver. METHODS: Difference in difference analysis was conducted of 1,320,790 adults aged 19-64 with family incomes at or below 138% of the federal poverty level from the 2010-2017 American Community Survey. Arkansas was compared to states that expanded without a waiver in calendar year 2014. States that expanded Medicaid with an approved Section 1115 waiver during the study period or expanded without a waiver after 2014 or did not expand Medicaid were excluded from the analysis. The outcome measures were no health insurance coverage, Medicaid coverage, employer sponsored private insurance, and non-group direct purchase private insurance. RESULTS: Arkansas's use of a waiver to expand Medicaid was associated with a lower uninsured rate (-3.7%, p< 0.001), a higher Medicaid coverage rate (2.0%, p< 0.001), and a higher non-group, direct purchase private insurance coverage rate (2.9%, p< 0.001) compared to states that expanded Medicaid in 2014 without a waiver. CONCLUSION: Compared to states that implemented traditional Medicaid expansion, we found that Arkansas's waiver was associated with increases in health insurance coverage rates.


Asunto(s)
Cobertura del Seguro/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Adulto , Arkansas , Femenino , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Patient Protection and Affordable Care Act , Pobreza , Estados Unidos , Adulto Joven
9.
Pediatrics ; 145(5)2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32295817

RESUMEN

BACKGROUND: Medicaid plays a critical role during the perinatal period, but pregnancy-related Medicaid eligibility only extends for 60 days post partum. In 2014, the Affordable Care Act's (ACA's) Medicaid expansions increased adult Medicaid eligibility to 138% of the federal poverty level in participating states, allowing eligible new mothers to remain covered after pregnancy-related coverage expires. We investigate the impact of ACA Medicaid expansions on insurance coverage among new mothers living in poverty. METHODS: We define new mothers living in poverty as women ages 19 to 44 with incomes below the federal poverty level who report giving birth in the past 12 months. We use 2010-2017 American Community Survey data and a difference-in-differences approach using parental Medicaid-eligibility thresholds to estimate the effect of ACA Medicaid expansions on insurance coverage among poor new mothers. RESULTS: A 100-percentage-point increase in parental Medicaid-eligibility is associated with an 8.8-percentage-point decrease (P < .001) in uninsurance, a 13.2-percentage-point increase (P < .001) in Medicaid coverage, and a 4.4-percentage-point decrease in private or other coverage (P = .001) among poor new mothers. The average increase in Medicaid eligibility is associated with a 28% decrease in uninsurance, a 13% increase in Medicaid coverage, and an 18% decline in private or other insurance among poor new mothers in expansion states. However, in 2017, there were ∼142 000 remaining uninsured, poor new mothers. CONCLUSIONS: ACA Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among poor new mothers. Opportunities remain for expansion and nonexpansion states to increase insurance coverage among new mothers living in poverty.


Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Cobertura del Seguro/economía , Medicaid/economía , Madres , Patient Protection and Affordable Care Act/economía , Pobreza/economía , Adulto , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Lactante , Recién Nacido , Cobertura del Seguro/tendencias , Medicaid/tendencias , Patient Protection and Affordable Care Act/tendencias , Pobreza/tendencias , Estados Unidos/epidemiología , Adulto Joven
11.
PLoS One ; 15(4): e0232097, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32324827

RESUMEN

INTRODUCTION: Uninsured patients have decreased access to care, lower rates of percutaneous coronary intervention (PCI), and worse outcomes after acute myocardial infarction (AMI). The aim of this study was to determine whether expanding insurance coverage through the Affordable Care Act's expansion of Medicaid eligibility affected access to PCI hospitals, rates of PCI, 30-day readmissions, and in-hospital mortality after AMI. METHODS: Quasi-experimental, difference-in-differences analysis of Medicaid and uninsured patients with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act, and Florida, which did not, from 2010-2015. This study accounts for the early expansion of Medicaid in certain California counties that began as early as July 2011. Main outcomes included rates of admission to PCI hospitals, rates of transfer for patients who initially presented to non-PCI hospitals, rates of PCI, rates of early PCI defined as within 48 hours of hospital admission, in-hospital mortality, and 30-day readmission. RESULTS: 55,991 hospital admissions between 2010-2015 met inclusion criteria. Of these, 32,540 were in California, which expanded Medicaid, and 23,451 were in Florida, which did not. 30-day readmission rates after AMI decreased by an absolute difference of 1.22 percentage points after the Medicaid expansion (95% CI -2.14 to -0.30, P < 0.01). This represented a relative decrease in readmission rates of 9.5% after AMI. No relationship between the Medicaid expansion and admission to PCI hospitals, transfer to PCI hospitals, rates of PCI, rates of early PCI, or in-hospital mortality were observed. CONCLUSIONS: Hospital readmissions decreased by 9.5% after the Affordable Care Act expanded Medicaid eligibility, although there was no association found between Medicaid expansion and access to PCI hospitals or treatment with PCI. Better understanding the ways that Medicaid expansion might affect care for vulnerable populations with AMI is important for policymakers considering whether to expand Medicaid eligibility in their state.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cobertura del Seguro/legislación & jurisprudencia , Cobertura del Seguro/estadística & datos numéricos , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/estadística & datos numéricos , Adulto , California , Estudios de Casos y Controles , Determinación de la Elegibilidad , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Medicaid , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Patient Protection and Affordable Care Act , Readmisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos
12.
Am Surg ; 86(3): 195-199, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223797

RESUMEN

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion (P = 0.56). Statewide data similarly demonstrated no change (P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients' decision to seek breast cancer screening and care.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer/economía , Costos de la Atención en Salud , Medicaid/economía , Evaluación de Resultado en la Atención de Salud , Adulto , Anciano , Neoplasias de la Mama/economía , Neoplasias de la Mama/mortalidad , Bases de Datos Factuales , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Ohio , Patient Protection and Affordable Care Act , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Estados Unidos
14.
Med Care ; 58(6): 526-533, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32205790

RESUMEN

OBJECTIVE: The objective of this study was to examine how pre-Affordable Care Act (ACA) state-level Medicaid expansions affect dual enrollment and utilization of Veterans Health Administration (VA) and Medicaid-funded care. RESEARCH DESIGN: We employed difference-in-difference analysis to determine the association between pre-ACA Medicaid expansions in New York and Arizona in 2001 and VA utilization. Participants' dual enrollment in Medicaid and VA, the distribution of their annual hospital admissions and emergency department (ED) visits between VA and Medicaid were dependent variables. We controlled for age, race, sex, disease burden, distance to VA facilities and income-based eligibility for VA services. MEASURES: Secondary data collected from 1999 to 2006 in 2 states expanding Medicaid and 3 demographically similar nonexpansion states. We obtained residency, enrollment and utilization data from VA's Corporate Data Warehouse and Medicaid Analytic Extract files. RESULTS: For low-income Veterans, Medicaid expansion was associated with increased dual enrollment of 4.87 percentage points (99% confidence interval: 4.48-5.25), a 4.63-point decline in VA proportion of admissions (-5.87 to -3.38), and a 11.70-point decrease in the VA proportion of ED visits (-13.06 to -10.34). Results also showed increases in the number of total (VA plus Medicaid) annual per-capita hospitalizations and ED visits among the group of VA enrollees most likely to be eligible for expansion. CONCLUSIONS: This study shows slight usage shifts when Veterans gain access to non-VA care. It highlights the need to overcome care-coordination challenges among VA patients as states implement ACA Medicaid expansion and policymakers consider additional expansions of public health insurance programs such as Medicare-for-All.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Servicios de Salud para Veteranos/estadística & datos numéricos , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Factores Sexuales , Factores Socioeconómicos , Estados Unidos
15.
Med Care ; 58(6): 574-578, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32221101

RESUMEN

BACKGROUND: Health care access increased for low-income Americans under the Affordable Care Act (ACA). It is unknown whether these changes in access were associated with improved self-reported health. OBJECTIVE: Determine changes in health care access, health behaviors, and self-reported health among low-income Americans over the first 4 years of the ACA, stratified by state Medicaid expansion status. DESIGN: Interrupted time series and difference-in-differences analysis. SUBJECTS: Noninstitutionalized US adults (18-64 y) in low income households (<138% federal poverty level) interviewed in the Behavioral Risk Factor Surveillance System 2011-2017 (N=505,824). MEASURES: Self-reported insurance coverage, access to a primary care physician, avoided care due to cost; self-reported general health, days of poor physical health, days of poor mental health days, and days when poor health limited usual activities; self-reported health behaviors, use of preventive services, and diagnoses. RESULTS: Despite increases in access, the ACA was not associated with improved physical or general health among low-income adults during the first 4 years of implementation. However, Medicaid expansion was associated with fewer days spent in poor mental health (-1.1 d/mo, 95% confidence interval: -2.1 to -0.5). There were significant changes in specific health behaviors, preventive service use, and diagnosis patterns during the same time period which may mediate the relationship between the ACA rollout and self-reported health. CONCLUSION: In nationally-representative survey data, we observed improvements in mental but not physical self-reported health among low-income Americans after 4 years of full ACA implementation.


Asunto(s)
Estado de Salud , Medicaid/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Adolescente , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Conductas Relacionadas con la Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Análisis de Series de Tiempo Interrumpido , Masculino , Salud Mental , Persona de Mediana Edad , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Servicios Preventivos de Salud/estadística & datos numéricos , Autoinforme , Estados Unidos , Adulto Joven
16.
BMC Public Health ; 20(1): 326, 2020 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-32169065

RESUMEN

BACKGROUND: HIV viral suppression is associated with health benefits for people living with HIV and a decreased risk of HIV transmission to others. The objective was to identify demographic, psychosocial, provider and neighborhood factors associated with sustained viral suppression among gay, bisexual, and other men who have sex with men. METHODS: Data from adult men who have sex with men (MSM) enrolled in the Miami-Dade County Ryan White Program (RWP) before 2017 were used. Sustained viral suppression was defined as having an HIV viral load < 200 copies/ml in all viral load tests in 2017. Three-level (individual, medical case management site, and neighborhood) cross-classified mixed-effect models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for sustained viral suppression. RESULTS: Of 3386 MSM, 90.8% were racial/ethnic minorities, and 84.4% achieved sustained viral suppression. The odds of achieving sustained viral suppression was lower for 18-24 and 25-34 year-old MSM compared with 35-49 year-old MSM, and for non-Latino Black MSM compared with White MSM. Those not enrolled in the Affordable Care Act, and those with current AIDS symptoms and a history of AIDS had lower odds of achieving sustained viral suppression. Psychosocial factors significantly associated with lower odds of sustained viral suppression included drug/alcohol use, mental health symptoms, homelessness, and transportation to appointment needs. Individuals with an HIV physician who serves a larger volume of RWP clients had greater odds of sustained viral suppression. Neighborhood factors were not associated with sustained viral suppression. CONCLUSION: Despite access to treatment, age and racial disparities in sustained viral suppression exist among MSM living with HIV. Addressing substance use, mental health, and social services' needs may improve the ability of MSM to sustain viral suppression long-term. Furthermore, physician characteristics may be associated with HIV outcomes and should be explored further.


Asunto(s)
Infecciones por VIH/terapia , Disparidades en el Estado de Salud , Homosexualidad Masculina/estadística & datos numéricos , Respuesta Virológica Sostenida , Adulto , Factores de Edad , Grupos Étnicos/estadística & datos numéricos , Florida , Infecciones por VIH/etnología , Personal de Salud/estadística & datos numéricos , Homosexualidad Masculina/etnología , Homosexualidad Masculina/psicología , Humanos , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Características de la Residencia/estadística & datos numéricos
17.
PLoS One ; 15(3): e0230121, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32203556

RESUMEN

BACKGROUND: People living with HIV (PLWH) residing in rural areas experience substantial barriers to HIV care, which may contribute to poor HIV health outcomes, including retention in HIV care and viral suppression. The Health Resources and Services Administration's Ryan White HIV/AIDS Program (HRSA RWHAP) is an important source of HIV medical care and support services in rural areas. The purpose of this analysis was to (1) assess the reach of the RWHAP in rural areas of the United States, (2) compare the characteristics and funded services of RWHAP provider organizations in rural and non-rural areas, and (3) compare the characteristics and clinical outcomes of RWHAP clients accessing medical care and support services in rural and non-rural areas. METHODS AND FINDINGS: Data for this analysis were abstracted from the 2017 RWHAP Services Report (RSR), the primary source of annual, client-level RWHAP data. Organizations funded to deliver RWHAP any service ("RWHAP providers") were categorized as rural or non-rural according to the HRSA FORHP's definition of modified Rural-Urban Commuting Area (RUCA) codes. RWHAP clients were categorized based on their patterns of RWHAP service use as "visited only rural providers," "visited only non-rural providers," or "visited rural and non-rural providers." In 2017, among the 2,113 providers funded by the RWHAP, 6.2% (n = 132) were located in HRSA-designated rural areas. Rural providers were funded to deliver a greater number of service categories per site than non-rural providers (44.7% funded for ≥5 services vs. 34.1% funded for ≥5 services, respectively). Providers in rural areas served fewer clients than providers in non-rural areas; 47.3% of RWHAP providers in rural areas served 1-99 clients, while 29.6% of non-rural providers served 1-99 clients. Retention in care and viral suppression outcomes did not differ on the basis of whether a client accessed services from rural or non-rural providers. CONCLUSIONS: RWHAP providers are a crucial component of HIV care delivery in the rural United States despite evidence of significant barriers to engagement in care for rural PLWH, RWHAP clients who visited rural providers were just as likely to be retained in care and reach viral suppression as their counterparts who visited non-rural providers. The RWHAP, especially in partnership with Rural Health Clinics and federally funded Health Centers, has the infrastructure and expertise necessary to address the HIV epidemic in rural America.


Asunto(s)
Prestación de Atención de Salud/normas , Infecciones por VIH/terapia , Accesibilidad a los Servicios de Salud , Patient Protection and Affordable Care Act/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , United States Health Resources and Services Administration/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Administración Financiera , Geografía , VIH/aislamiento & purificación , Infecciones por VIH/diagnóstico , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act/organización & administración , Patient Protection and Affordable Care Act/normas , Características de la Residencia , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/normas , Personas Transgénero , Resultado del Tratamiento , Estados Unidos/epidemiología , United States Health Resources and Services Administration/organización & administración , United States Health Resources and Services Administration/normas , Adulto Joven
18.
J Am Dent Assoc ; 151(3): 182-189, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32130947

RESUMEN

BACKGROUND: The dependent coverage mandate policy of the Patient Protection and Affordable Care Act led to spillover increases in private dental coverage among affected young adults. The authors investigate whether such gains were widely shared across racial or ethnic groups and shared across income levels. The authors further explore the relationship between dental coverage and dental services use stratified by race or ethnicity and income using the mandate as a natural experiment. METHODS: Using nationally representative Medical Expenditure Panel Survey data from 2006 through 2015, the authors used a difference-in-difference regression approach comparing changes in private dental coverage and dental services use for 19- through 25-year-olds affected by the policy with those for unaffected 27- through 30-year-olds. The authors stratified the model by race or ethnicity and income to understand potential differences in the effects of the mandate across these groups. RESULTS: The authors found significant increases in private dental coverage across all racial or ethnic groups as well as across higher- and lower-income young adults. However, despite notable increases in private dental coverage, the authors found little evidence of any overall effects on dental services use. The authors did find evidence suggesting an increased relative likelihood of dental visits for 19- through 25-year-old non-Hispanic blacks compared with slightly older non-Hispanic blacks. CONCLUSIONS: The spillover effect of the dependent coverage mandate on private dental coverage was widely shared across racial or ethnic groups and across income levels. PRACTICAL IMPLICATIONS: Among young adults aged 19 through 25 years, increases in private dental coverage may not be enough on its own to increase the use of preventive dental services and ultimately lead to improved oral health.


Asunto(s)
Gastos en Salud , Patient Protection and Affordable Care Act , Adulto , Atención Odontológica , Humanos , Cobertura del Seguro , Seguro de Salud , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
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