《平价医疗法案》中年轻成年人保险扩展对医院心理健康护理的影响。
Effect of the Affordable Care Act's young adult insurance expansions on hospital-based mental health care.
作者信息
Golberstein Ezra, Busch Susan H, Zaha Rebecca, Greenfield Shelly F, Beardslee William R, Meara Ellen
机构信息
From the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis; the Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn.; the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, N.H.; the Department of Psychiatry, McLean Hospital, Belmont, Mass., and Harvard Medical School, Boston; the Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston; and the National Bureau of Economic Research, Cambridge, Mass.
出版信息
Am J Psychiatry. 2015 Feb 1;172(2):182-9. doi: 10.1176/appi.ajp.2014.14030375. Epub 2014 Oct 31.
OBJECTIVE
Insurance coverage for young adults has increased since 2010, when the Affordable Care Act (ACA) required insurers to permit children to remain on parental policies until age 26 as dependents. This study estimated the association between the dependent coverage provision and changes in young adults' use of hospital-based services for substance use disorders and non-substance use psychiatric disorders.
METHOD
The authors conducted a quasi-experimental comparison of a national sample of non-childbirth-related inpatient admissions to general hospitals (a total of 2,670,463 admissions, 430,583 of which had primary psychiatric diagnoses) and California emergency department visits with psychiatric diagnoses (N=11,139,689), using data spanning 2005 to 2011. Analyses compared young adults who were targeted by the ACA dependent coverage provision (19- to 25-year-olds) and those who were not (26- to 29-year-olds), estimating changes in utilization before and after implementation of the dependent coverage provision. Primary outcome measures included quarterly inpatient admissions for primary diagnoses of any psychiatric disorder per 1,000 population; emergency department visits with any psychiatric diagnosis per 1,000 population; and payer source.
RESULTS
Dependent coverage expansion was associated with 0.14 more inpatient admissions for psychiatric diagnoses per 1,000 for 19- to 25-year-olds (targeted by the ACA) than for 26- to 29-year-olds (not targeted by the ACA). The coverage expansion was associated with 0.45 fewer psychiatric emergency department visits per 1,000 in California. The probability that inpatient admissions nationally and emergency department visits in California were uninsured decreased significantly.
CONCLUSIONS
ACA dependent coverage provisions produced modest increases in general hospital psychiatric inpatient admissions and higher rates of insurance coverage for young adults nationally. Lower rates of emergency department visits were observed in California.
目的
自2010年《平价医疗法案》（ACA）要求保险公司允许子女作为受抚养人继续留在父母的保险政策下直至26岁以来，美国年轻人的保险覆盖率有所提高。本研究估计了受抚养人保险条款与年轻人使用医院治疗物质使用障碍和非物质使用精神障碍服务变化之间的关联。
方法
作者对综合医院与分娩无关的住院患者全国样本（共2670463例入院，其中430583例有原发性精神疾病诊断）和加利福尼亚州有精神疾病诊断的急诊科就诊患者（N = 11139689）进行了准实验比较，使用了2005年至2011年的数据。分析比较了ACA受抚养人保险条款针对的年轻人（19至25岁）和未针对的年轻人（26至29岁），估计了受抚养人保险条款实施前后的使用变化。主要结局指标包括每1000人口中因任何精神疾病原发性诊断的季度住院入院人数；每1000人口中有任何精神疾病诊断的急诊科就诊人数；以及付款人来源。
结果
与26至29岁（未被ACA针对）的年轻人相比，受抚养人保险覆盖范围扩大使19至25岁（被ACA针对）的年轻人每1000人中因精神疾病诊断的住院入院人数增加了0.14例。保险覆盖范围扩大使加利福尼亚州每1000人中精神科急诊科就诊人数减少了0.45例。全国住院入院和加利福尼亚州急诊科就诊未参保的概率显著降低。
结论
ACA受抚养人保险条款使综合医院精神科住院入院人数略有增加，全国年轻人的保险覆盖率提高。在加利福尼亚州观察到急诊科就诊率较低。
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