Dr. Thomas is with Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill. Dr. Shartzer is with the Urban Institute, Washington, D.C. Ms. Kurth and Dr. Hall are with the Institute for Health and Disability Policy Studies, Lawrence, Kansas. Dr. Hall is also with the Department of Health Policy and Management, University of Kansas Medical Center, Kansas City.
Psychiatr Serv. 2018 Feb 1;69(2):231-234. doi: 10.1176/appi.ps.201700044. Epub 2017 Nov 15.
This brief report explores the impact of health reform for people with mental illness.
The Health Reform Monitoring Survey was used to examine health insurance, access to care, and employment for 1,550 people with mental health conditions pre- and postimplementation of the Affordable Care Act (ACA) and by state Medicaid expansion status. Multivariate logistic regressions with predictive margins were used.
Post-ACA reforms, people with mental health conditions were less likely to be uninsured (5% versus 13%; t=-6.89, df=50, p<.001) and to report unmet need due to cost of mental health care (17% versus 21%; t=-3.16, df=50, p=.002) and any health services (46% versus 51%; t=-3.71, df=50, p<.001), and they were more likely to report a usual source of care (82% versus 76%; t=3.11, df=50, p=.002). These effects were experienced in both Medicaid expansion and nonexpansion states.
Findings underscore the importance of ACA improvements in the quality of health insurance coverage.
本简要报告探讨了医疗改革对精神病患者的影响。
使用《健康改革监测调查》，在《平价医疗法案》（ACA）实施前后以及各州医疗补助扩张状况下，调查了 1550 名有心理健康状况人群的医疗保险、获得医疗服务的机会和就业情况。采用具有预测边缘的多元逻辑回归。
ACA 改革后，心理健康状况患者的未参保率（5%比 13%；t=-6.89，df=50，p<.001）和因精神保健费用而未获得医疗服务的比例（17%比 21%；t=-3.16，df=50，p=.002）以及任何医疗服务（46%比 51%；t=-3.71，df=50，p<.001）都有所下降，且更有可能报告有常规医疗来源（82%比 76%；t=3.11，df=50，p=.002）。这些影响在医疗补助扩张和不扩张的州都有体现。
研究结果强调了 ACA 在改善医疗保险覆盖质量方面的重要性。
