Scott John W, Rose John A, Tsai Thomas C, Zogg Cheryl K, Shrime Mark G, Sommers Benjamin D, Salim Ali, Haider Adil H
*Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health †Program For Global Surgery And Social Change, Harvard Medical School ‡Department of Health Policy and Management, Harvard T.H. Chan School of Public Health §Massachusetts Eye & Ear Infirmary, Department Of Otolaryngology & Office of Global Surgery ∥Department of Medicine, Brigham & Women's Hospital ¶Department of Surgery, Division of Trauma, Brigham & Women's Hospital, Boston, MA.
Med Care. 2016 Sep;54(9):818-26. doi: 10.1097/MLR.0000000000000586.
The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act allowed young adults to remain on their parents' health insurance plans until age 26 years. Although the provision improved coverage and survey-reported access to care, little is known regarding its impact on timely access for acute conditions. This study aims to assess changes in insurance coverage and perforation rates among young adults with acute appendicitis-an established metric for population-level health care access-after the DCP.
The National Inpatient Sample and difference-in-differences linear regression were used to assess prepolicy/postpolicy changes for policy-eligible young adults (aged 19-25 y) compared with a slightly older, policy-ineligible comparator group (aged 26-34 y).
After adjustment for covariates, 19-25 year olds experienced a 3.6-percentage point decline in the uninsured rate after the DCP (baseline 22.5%), compared with 26-34 year olds (P<0.001). This coincided with a 1.4-percentage point relative decline in perforated appendix rate for 19-25 year olds (baseline 17.5%), compared with 26-34 year olds (P=0.023). All subgroups showed significant reductions in uninsured rates; however, statistically significant reductions in perforation rates were limited to racial/ethnic minorities, patients from lower-income communities, and patients presenting to urban teaching hospitals.
Reductions in uninsured rates among young adults after the DCP were associated with significant reductions in perforated appendix rates relative to a comparator group, suggesting that insurance expansion could lead to fewer delays in seeking and accessing care for acute conditions. Greater relative declines in perforation rates among the most at-risk subpopulations hold important implications for the use of coverage expansion to mitigate existing disparities in access to care.
《平价医疗法案》2010年的受抚养人保险条款（DCP）允许年轻人在26岁之前继续加入其父母的医疗保险计划。尽管该条款提高了保险覆盖率，并改善了调查中报告的医疗服务可及性，但对于其对急性病及时就医的影响却知之甚少。本研究旨在评估DCP实施后，患有急性阑尾炎的年轻人（这是衡量人群层面医疗服务可及性的既定指标）的保险覆盖率和穿孔率变化。
使用全国住院患者样本和差异中的差异线性回归，来评估符合政策的年轻人（19 - 25岁）在政策实施前后的变化，并与年龄稍大、不符合政策的对照组（26 - 34岁）进行比较。
在对协变量进行调整后，与26 - 34岁的人群相比，19 - 25岁的人群在DCP实施后未参保率下降了3.6个百分点（基线为22.5%）（P<0.001）。与此同时，与26 - 34岁的人群相比，19 - 25岁的人群阑尾穿孔率相对下降了1.4个百分点（基线为17.5%）（P = 0.023）。所有亚组的未参保率均显著降低；然而，穿孔率的统计学显著降低仅限于少数种族/族裔、来自低收入社区的患者以及在城市教学医院就诊的患者。
DCP实施后年轻人未参保率的降低与相对于对照组阑尾穿孔率的显著降低相关，这表明保险覆盖范围的扩大可能会减少急性病就医的延误。风险最高的亚人群中穿孔率相对下降幅度更大，这对于利用扩大保险覆盖范围来缓解现有医疗服务可及性差异具有重要意义。
