McKenna Ryan M
Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Nesbitt Hall 3rd Floor, Philadelphia, PA 19104, USA.
Drug Alcohol Depend. 2017 Oct 1;179:87-92. doi: 10.1016/j.drugalcdep.2017.06.028. Epub 2017 Jul 24.
Despite increasing rates of opioid misuse and hospitalizations, rates of treatment for those with opioid use disorder (OUD) are very low. This study examined the impact of the Patient Protection and Affordable Care Act's (ACA) insurance expansion on improving rates of insurance, health care access, and treatment for those with OUD.
Data on individuals ages 18-64 with OUD come from the 2008-2014 National Survey on Drug Use and Health (N=4100). Multivariable logistic regression analyses were performed to estimate the trends of health care insurance, treatment and barriers to care across the stages of ACA implementation: pre-ACA (2008-2009), partial-ACA (2010-2013), and national implementation (2014). All models were adjusted for predisposing, enabling, and need factors.
In both adjusted and unadjusted comparisons, national implementation of the ACA was associated with significant improvements in outcome measures for those with OUD. Multivariable analyses indicate that, after national implementation, those with OUD were significantly less likely to be uninsured and were less likely to report financial barriers as a reason for not receiving substance use treatment, relative to the pre-ACA period. Individuals were also more likely to receive substance use treatment and were more likely to report that insurance paid for treatment after national implementation of the ACA relative to the pre-ACA period. These results persisted when national implementation was compared relative to partial-implementation.
National implementation of the ACA has helped to reduce rates of uninsurance, barriers to care, and improve rates of substance use treatment for those with OUD.
尽管阿片类药物滥用和住院率不断上升，但阿片类药物使用障碍（OUD）患者的治疗率却非常低。本研究考察了《患者保护与平价医疗法案》（ACA）保险扩展对提高OUD患者的保险覆盖率、医疗保健可及性及治疗率的影响。
有关18至64岁OUD患者的数据来自2008 - 2014年全国药物使用和健康调查（N = 4100）。进行多变量逻辑回归分析，以估计在ACA实施各阶段（ACA实施前（2008 - 2009年）、部分实施ACA阶段（2010 - 2013年）和全面实施阶段（2014年））的医疗保险、治疗及医疗障碍的趋势。所有模型均针对易患因素、促成因素和需求因素进行了调整。
在调整和未调整的比较中，ACA的全面实施都与OUD患者结局指标的显著改善相关。多变量分析表明，在全面实施后，与ACA实施前相比，OUD患者未参保的可能性显著降低，因经济障碍而未接受药物使用治疗的可能性也降低。与ACA实施前相比，在ACA全面实施后，个体接受药物使用治疗的可能性更大，且更有可能报告保险支付了治疗费用。与部分实施阶段相比，全面实施阶段时这些结果依然成立。
ACA的全面实施有助于降低OUD患者的未参保率、医疗障碍，并提高药物使用治疗率。
