Feder Kenneth A, Mojtabai Ramin, Krawczyk Noa, Young Andrea S, Kealhofer Marc, Tormohlen Kayla N, Crum Rosa M
Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway, Baltimore, MD 21205, United States.
Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway, Baltimore, MD 21205, United States.
Drug Alcohol Depend. 2017 Oct 1;179:271-274. doi: 10.1016/j.drugalcdep.2017.07.015. Epub 2017 Aug 9.
This short communication examines the impact of the Patient Protection and Affordable Care Act (PPACA) on insurance coverage and substance use treatment access among persons with opioid use disorders.
Data came from the 2010-2015 National Surveys on Drug Use and Health. Among persons with heroin and opioid pain-reliever use disorders, measures of insurance coverage and treatment access were compared before and after the implementation of major PPACA provisions that expanded access to insurance in 2014.
The prevalence of uninsured persons among those with heroin use disorders declined dramatically following PPACA implementation (OR 0.59, 95% CI 0.39-0.89), largely due to an increase in the prevalence of Medicaid coverage (OR 1.96, 95% CI 1.21-3.18). There was no evidence of an increase in the prevalence of treatment, but among persons who received treatment, there was an increase in the proportion whose treatment was paid for by insurance (OR 3.75, 95% CI 2.13-3.18). By contrast, there was no evidence the uninsured rate declined among persons with pain-reliever use disorders.
The PPACA Medicaid expansion increased insurance coverage among persons with heroin use disorders, and likely plays an essential role in protecting the health and financial security of this high-risk group. More research is needed on the relationship between insurance acquisition and utilization of substance use treatment.
本简短通讯探讨了《患者保护与平价医疗法案》（PPACA）对阿片类药物使用障碍患者的保险覆盖情况及物质使用治疗可及性的影响。
数据来自2010 - 2015年全国药物使用和健康调查。在患有海洛因和阿片类止痛药物使用障碍的人群中，比较了2014年扩大保险可及性的PPACA主要条款实施前后的保险覆盖情况及治疗可及性指标。
PPACA实施后，患有海洛因使用障碍者中未参保者的比例大幅下降（比值比0.59，95%置信区间0.39 - 0.89），这主要归因于医疗补助覆盖比例的增加（比值比1.96，95%置信区间1.21 - 3.18）。没有证据表明治疗比例增加，但在接受治疗的人群中，由保险支付治疗费用的比例有所增加（比值比3.75，95%置信区间2.13 - 3.18）。相比之下，没有证据表明患有止痛药物使用障碍者的未参保率下降。
PPACA的医疗补助扩大增加了患有海洛因使用障碍者的保险覆盖，并且可能在保护这一高危群体的健康和经济安全方面发挥了重要作用。关于保险获取与物质使用治疗利用之间的关系，还需要更多研究。
