Clark Cheryl R, Ommerborn Mark J, A Coull Brent, Pham Do Quyen, Haas Jennifer S
*The Center for Community Health and Health Equity, Brigham and Women's Hospital †Brigham and Women's-Faulkner Hospitalist Program ‡Division of General Medicine and Primary Care, Brigham and Women's Hospital §Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA.
Med Care. 2016 Jun;54(6):555-61. doi: 10.1097/MLR.0000000000000525.
Monitoring political and social determinants of delayed or forgone care due to cost is necessary to evaluate efforts to reduce racial and ethnic disparities in access to care. Our objective was to examine the extent to which state Medicaid expansion decisions and personal household income may be associated with individual-level racial and ethnic disparities in delayed or forgone care due to cost, at baseline, before the implementation of the Affordable Care Act.
We used 2012 Behavioral Risk Factor Surveillance System survey data to examine racial and ethnic differences in delayed or forgone care due to cost in states that do and do not plan Medicaid expansion. We examined personal household income as a social factor that could contribute to racial and ethnic disparities in delayed or forgone care.
We found that personal income differences were strongly related to disparities in delayed or forgone care in places with and without plans to expand Medicaid. In addition, while delayed or forgone care disparities between non-Hispanic whites and non-Hispanic blacks were lowest in places with plans to expand Medicaid access, disparities between non-Hispanic whites and Hispanics did not differ by state Medicaid expansion plans.
As access to insurance improves for diverse groups, health systems must develop innovative strategies to overcome social determinants of health, including income inequities, as barriers to accessing care for Hispanic and non-Hispanic blacks. Additional efforts may be needed to ensure Hispanic groups achieve the benefits of investments in health care access.
监测因费用问题导致的延迟或放弃治疗的政治和社会决定因素，对于评估为减少医疗服务获取方面的种族和族裔差异所做的努力至关重要。我们的目标是在《平价医疗法案》实施之前的基线水平上，研究州医疗补助扩大决策和个人家庭收入在多大程度上可能与因费用导致的延迟或放弃治疗方面的个体层面种族和族裔差异相关。
我们使用2012年行为危险因素监测系统调查数据，研究计划扩大医疗补助和不计划扩大医疗补助的州中，因费用导致的延迟或放弃治疗方面的种族和族裔差异。我们将个人家庭收入作为一个可能导致延迟或放弃治疗方面种族和族裔差异的社会因素进行研究。
我们发现，无论所在州有无扩大医疗补助的计划，个人收入差异都与延迟或放弃治疗方面的差异密切相关。此外，虽然在计划扩大医疗补助覆盖范围的地区，非西班牙裔白人和非西班牙裔黑人之间因费用导致的延迟或放弃治疗的差异最小，但非西班牙裔白人和西班牙裔之间的差异并不因州医疗补助扩大计划而有所不同。
随着不同群体的保险覆盖范围不断扩大，卫生系统必须制定创新策略，以克服健康的社会决定因素，包括收入不平等，因为这些因素是西班牙裔和非西班牙裔黑人获取医疗服务的障碍。可能需要做出更多努力，以确保西班牙裔群体能够从医疗服务获取方面的投资中受益。
