Alcalá Héctor E, Chen Jie, Langellier Brent A, Roby Dylan H, Ortega Alexander N
From the Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville (HEA); the Department of Health Services Administration, School of Public Health, University of Maryland, College Park (JC, DHR); and the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA (BAL, ANO).
J Am Board Fam Med. 2017 Jan 2;30(1):52-62. doi: 10.3122/jabfm.2017.01.160208.
In the United States, Latinos have poorer access to and utilization of health care than non-Latino whites. The Patient Protection and Affordable Care Act (ACA) may reduce these disparities. The ACA's impact among Latino subgroups is unknown.
Using the 2011 to 2015 National Health Interview Survey, we examined access to and utilization of health care by Latino subgroups (18-64 years old). Subgroups were defined by Latino heritage group, citizenship status, and language use. Measures of access and utilization included insurance status, delaying medical care, forgoing medical care, visiting the emergency department, and visiting a physician. Logistic regression models were used to estimate the odds of the outcomes. Time period and subgroup interaction terms were used to test the effects of the ACA.
Mexicans and Central Americans had lower odds of being insured than did non-Latino whites. After ACA implementation, most reductions in disparities occurred between Puerto Ricans and non-Latino whites. Limited impact of the ACA was observed by language and citizenship status.
The ACA has reduced gaps in access to and utilization of health care for some Latino population subgroups. Remaining disparities necessitate policy solutions that move beyond the ACA, particularly for groups excluded from coverage options, such as noncitizens.
在美国，拉丁裔比非拉丁裔白人获得医疗保健的机会更少，医疗保健利用率也更低。《患者保护与平价医疗法案》（ACA）可能会减少这些差距。ACA对拉丁裔亚群体的影响尚不清楚。
利用2011年至2015年的全国健康访谈调查，我们研究了拉丁裔亚群体（18至64岁）获得医疗保健的机会和医疗保健利用率。亚群体由拉丁裔血统群体、公民身份和语言使用情况来定义。获得医疗保健机会和利用率的衡量指标包括保险状况、推迟就医、放弃就医、前往急诊科就诊以及看医生。使用逻辑回归模型来估计结果的几率。使用时间段和亚群体交互项来检验ACA的效果。
墨西哥人和中美洲人参保的几率低于非拉丁裔白人。ACA实施后，大多数差距的缩小发生在波多黎各人和非拉丁裔白人之间。按语言和公民身份状况观察到ACA的影响有限。
ACA缩小了一些拉丁裔人群亚群体在获得医疗保健机会和医疗保健利用率方面的差距。仍然存在的差距需要超越ACA的政策解决方案，特别是针对那些被排除在保险选项之外的群体，如非公民。
