UCLA/Department of Veterans Affairs National Clinicians Scholar Program, Los Angeles, California; Department of Urology, Los Angeles, California.
David Geffen School of Medicine at UCLA, Los Angeles, California.
J Urol. 2018 Jul;200(1):74-81. doi: 10.1016/j.juro.2018.01.084. Epub 2018 Feb 6.
We evaluated the effect of transitioning from a prostate cancer specific treatment program to comprehensive insurance under the ACA (Patient Protection and Affordable Care Act) on the physical, mental and prostate cancer related health of poor, previously uninsured men.
We assessed general and prostate cancer specific health related quality of life using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and the UCLA PCI (Prostate Cancer Index) at 3 time points in 24 men who transitioned to comprehensive insurance as the insured group relative to 39 who remained in the prostate cancer program as the control group. We used mixed effects models controlling for treatment and patient factors to measure health differences between the groups during the transition period.
Demographics, prostate cancer treatment patterns, and mental, physical and general health were similar before transition in the control and insured groups. After transition men who gained insurance coverage reported significantly worse physical health than men who remained in the prostate cancer program (p = 0.0038). After adjustment in the mixed effects model physical health remained worse in men who gained insurance (p = 0.0036). Mental health and prostate cancer related quality of life did not differ with time between the groups.
Compared to controls who remained in the state funded prostate cancer treatment program for poor, uninsured men, newly insured men reported worse physical health after transitioning to ACA coverage. Providers and policy makers may draw important lessons from understanding the mechanisms of this paradoxical worsening in physical health after gaining insurance. These results inform the development of disease specific models of care in the broader health insurance context.
我们评估了从针对前列腺癌的特定治疗方案过渡到平价医疗法案（Patient Protection and Affordable Care Act）下的综合保险对贫困、以前未投保的男性的身体、心理和前列腺癌相关健康的影响。
我们使用 RAND SF-12v2™（12 项简短健康调查，第二版）和 UCLA PCI（前列腺癌指数）评估了 24 名过渡到综合保险的男性（保险组）和 39 名仍在前列腺癌计划中的男性（对照组）的一般和前列腺癌特异性健康相关生活质量，在三个时间点进行评估。我们使用混合效应模型控制治疗和患者因素，以衡量过渡期间两组之间的健康差异。
在对照组和保险组中，人口统计学、前列腺癌治疗模式以及心理、身体和一般健康状况在过渡前相似。在过渡后，获得保险覆盖的男性报告的身体健康状况明显比仍在前列腺癌计划中的男性差（p = 0.0038）。在混合效应模型的调整后，获得保险的男性的身体健康状况仍然更差（p = 0.0036）。心理健康和前列腺癌相关生活质量在两组之间没有随时间的差异。
与仍在为贫困、未投保的男性提供的州立前列腺癌治疗计划中的对照组相比，新获得保险的男性在过渡到平价医疗法案覆盖后报告的身体健康状况更差。了解获得保险后身体健康状况恶化这一悖论的机制，为提供者和政策制定者提供了重要的经验教训。这些结果为在更广泛的健康保险背景下制定特定疾病的护理模式提供了信息。
