Winkelman Tyler N A, Kieffer Edith C, Goold Susan D, Morenoff Jeffrey D, Cross Kristen, Ayanian John Z
Robert Wood Johnson Foundation Clinical Scholars Program, North Campus Research Center (NCRC), University of Michigan, Ann Arbor, MI, USA.
VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
J Gen Intern Med. 2016 Dec;31(12):1523-1529. doi: 10.1007/s11606-016-3845-5.
A large proportion of justice-involved individuals have mental health issues and substance use disorders (SUD) that are often untreated due to high rates of uninsurance. However, roughly half of justice-involved individuals were estimated to be newly eligible for health insurance through the Affordable Care Act (ACA).
We aimed to assess health insurance trends among justice-involved individuals before and after implementation of the ACA's key provisions, the dependent coverage mandate and Medicaid expansion, and to examine the relationship between health insurance and treatment for behavioral health conditions.
Repeated and pooled cross-sectional analyses of data from the National Survey on Drug Use and Health (NSDUH).
Nationally representative sample of 15,899 adults age 19-64 years between 2008 and 2014 with a history of justice involvement during the prior 12 months.
Uninsurance rates between 2008 and 2014 are reported. Additional outcomes include adjusted treatment rates for depression, serious mental illness, and SUD by insurance status.
The dependent coverage mandate was associated with a 13.0 percentage point decline in uninsurance among justice-involved individuals age 19-25 years (p < 0.001). Following Medicaid expansion, uninsurance declined among justice involved individuals of all ages by 9.7 percentage points (p < 0.001), but remained 16.3 percentage points higher than uninsurance rates for individuals without justice involvement (p < 0.001). In pooled analyses, Medicaid, relative to uninsurance and private insurance, was associated with significantly higher treatment rates for illicit drug abuse/dependence and depression.
Given the high prevalence of mental illness and substance use disorders among justice-involved populations, persistently elevated rates of uninsurance and other barriers to care remain a significant public health concern. Sustained outreach is required to reduce health insurance disparities between individuals with and without justice involvement. Public insurance appears to be associated with higher treatment rates, relative to uninsurance and private insurance, among justice-involved individuals.
很大一部分涉及司法系统的人存在心理健康问题和物质使用障碍（SUD），由于未参保率高，这些问题往往得不到治疗。然而，据估计，大约一半涉及司法系统的人通过《平价医疗法案》（ACA）新获得了医疗保险资格。
我们旨在评估ACA关键条款（受抚养人保险授权和医疗补助扩大）实施前后涉及司法系统的人的医疗保险趋势，并研究医疗保险与行为健康状况治疗之间的关系。
对来自全国药物使用和健康调查（NSDUH）的数据进行重复和汇总的横断面分析。
2008年至2014年间，从全国范围内抽取的15899名19至64岁成年人作为代表性样本，这些人在过去12个月内有涉及司法系统的经历。
报告了2008年至2014年期间的未参保率。其他结果包括按保险状况调整后的抑郁症、严重精神疾病和SUD的治疗率。
受抚养人保险授权与19至25岁涉及司法系统的人的未参保率下降13.0个百分点相关（p<0.001）。医疗补助扩大后，所有年龄段涉及司法系统的人的未参保率下降了9.7个百分点（p<0.001），但仍比未涉及司法系统的人的未参保率高16.3个百分点（p<0.001）。在汇总分析中，与未参保和私人保险相比，医疗补助与非法药物滥用/依赖和抑郁症的治疗率显著更高相关。
鉴于涉及司法系统人群中心理疾病和物质使用障碍的高患病率，持续居高不下的未参保率和其他护理障碍仍然是一个重大的公共卫生问题。需要持续开展宣传工作，以减少有和没有涉及司法系统经历的人之间的医疗保险差距。相对于未参保和私人保险，公共保险在涉及司法系统的人中似乎与更高的治疗率相关。
