Tumin Dmitry, Li Susan S, Kopp Benjamin T, Kirkby Stephen E, Tobias Joseph D, Morgan Wayne J, Hayes Don
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Pediatr Pulmonol. 2017 Apr;52(4):458-466. doi: 10.1002/ppul.23648. Epub 2017 Feb 2.
The Patient Protection and Affordable Care Act (ACA), enacted in 2010, expanded private insurance coverage of young adults through the dependent coverage provision. This policy's implications for patients with cystic fibrosis (CF) are unknown.
The CF Foundation Patient Registry was used to identify patients seen at CF centers, 3 years before and after ACA implementation. Patients were grouped according to eligibility for the dependent care provision (18-25 years old in 2010) or ineligibility (26-35 years old). Year-level difference-in-difference logistic regressions evaluated the association between ACA enactment and insurance status (private, public, or no insurance). Routine annual care consistent with CF Foundation guidelines (≥4 clinic visits, ≥4 respiratory cultures, and ≥2 pulmonary function tests/year) was a secondary outcome.
The analysis included 4,024 and 3,132 patients in the eligible and ineligible groups, respectively (35,353 patient-years). In the eligible group, 62% had private insurance before and after ACA; 18% had public insurance before and after ACA; and 5% switched from public to private insurance. In the eligible group, lack of insurance coverage became more common in the post-ACA period (relative risk ratio vs. private insurance [RRR] = 1.95; 95%CI: 1.57, 2.43; P < 0.001). Public insurance coverage also became more common (RRR = 1.50; 95%CI: 1.39, 1.62; P < 0.001). Use of routine care increased post-ACA, but more strongly in the ineligible group than in the eligible group.
The ACA dependent coverage provision did not increase private insurance coverage or use of routine care among CF patients who were potentially affected by this policy. Pediatr Pulmonol. 2017;52:458-466. © 2017 Wiley Periodicals, Inc.
2010年颁布的《患者保护与平价医疗法案》（ACA）通过受抚养人保险条款扩大了年轻人的私人保险覆盖范围。该政策对囊性纤维化（CF）患者的影响尚不清楚。
利用CF基金会患者登记系统识别ACA实施前后3年内在CF中心就诊的患者。患者根据是否符合受抚养人护理条款的资格（2010年为18 - 25岁）或不符合资格（26 - 35岁）进行分组。年度差异-差异逻辑回归评估了ACA颁布与保险状况（私人保险、公共保险或无保险）之间的关联。符合CF基金会指南的常规年度护理（每年≥4次门诊就诊、≥4次呼吸道培养和≥2次肺功能测试）是次要结果。
分析分别纳入了符合资格组和不符合资格组的4024例和3132例患者（35353患者年）。在符合资格组中，ACA实施前后62%的患者有私人保险；ACA实施前后18%的患者有公共保险；5%的患者从公共保险转为私人保险。在符合资格组中，ACA实施后未参保的情况变得更为普遍（与私人保险相比的相对风险比[RRR]=1.95；95%置信区间：1.57, 2.43；P<0.001）。公共保险覆盖也变得更为普遍（RRR = 1.50；95%置信区间：1.39, 1.62；P<0.001）。ACA实施后常规护理的使用增加，但不符合资格组比符合资格组增加得更明显。
ACA的受抚养人保险条款并未增加可能受该政策影响的CF患者的私人保险覆盖范围或常规护理的使用。《儿科肺病学》。2017；52：458 - 466。©2017威利期刊公司。
