Winkelman Tyler N A, Choi HwaJung, Davis Matthew M
Tyler N. A. Winkelman is with the VA Ann Arbor Healthcare System, Ann Arbor, MI, and the Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan Medical School, Ann Arbor. HwaJung Choi is with the Department of Internal Medicine, University of Michigan Medical School. Matthew M. Davis is with the Division of Academic General Pediatrics, Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, and the Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago.
Am J Public Health. 2017 May;107(5):807-811. doi: 10.2105/AJPH.2017.303703. Epub 2017 Mar 21.
To estimate health insurance and health care utilization patterns among previously incarcerated men following implementation of the Affordable Care Act's (ACA's) Medicaid expansion and Marketplace plans in 2014.
We performed serial cross-sectional analyses using data from the National Survey of Family Growth between 2008 and 2015. Our sample included men aged 18 to 44 years with (n = 3476) and without (n = 8702) a history of incarceration.
Uninsurance declined significantly among previously incarcerated men after ACA implementation (-5.9 percentage points; 95% confidence interval [CI] = -11.5, -0.4), primarily because of an increase in private insurance (6.8 percentage points; 95% CI = 0.1, 13.3). Previously incarcerated men accounted for a large proportion of the remaining uninsured (38.6%) in 2014 to 2015. Following ACA implementation, previously incarcerated men continued to be significantly less likely to report a regular source of primary care and more likely to report emergency department use than were never-incarcerated peers.
Health insurance coverage improved among previously incarcerated men following ACA implementation. However, these men account for a substantial proportion of the remaining uninsured. Previously incarcerated men continue to lack primary care and frequently utilize acute care services.
评估2014年《平价医疗法案》（ACA）的医疗补助扩大计划和市场计划实施后，曾被监禁男性的医疗保险和医疗保健利用模式。
我们使用2008年至2015年全国家庭成长调查的数据进行了系列横断面分析。我们的样本包括18至44岁有监禁史（n = 3476）和无监禁史（n = 8702）的男性。
ACA实施后，曾被监禁男性的未参保率显著下降（-5.9个百分点；95%置信区间[CI] = -11.5，-0.4），主要原因是私人保险增加（6.8个百分点；95% CI = 0.1，13.3）。在2014年至2015年，曾被监禁男性在剩余未参保人群中占很大比例（38.6%）。ACA实施后，与从未被监禁过的同龄人相比，曾被监禁男性报告有常规初级保健来源的可能性仍然显著较低，而报告使用急诊科服务的可能性更高。
ACA实施后，曾被监禁男性的医疗保险覆盖范围有所改善。然而，这些男性在剩余未参保人群中占很大比例。曾被监禁男性仍然缺乏初级保健，且经常使用急性护理服务。
