Lin Chien-Jung, Novak Eric, Rich Michael W, Billadello Joseph J
Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Center for Adults with Congenital Heart Disease, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Congenit Heart Dis. 2018 May;13(3):384-391. doi: 10.1111/chd.12582. Epub 2018 Feb 26.
Adults with congenital heart disease (ACHD) have traditionally been viewed as an underinsured population. Whether this is true in the Affordable Care Act era is unknown. We determined insurance patterns in ACHD patients compared to the non-ACHD cardiology population in a contemporary cohort.
All cardiology outpatient visits between July 2016 and February 2017 to a large referral center in the United States were reviewed. The primary payer was categorized as health maintenance organization (HMO), preferred provider organization (PPO), Medicare, Medicaid, self-pay, or other. Diagnosis and lesion severity of ACHD were extracted from ICD-10 diagnostic codes and assigned according to the 2008 American College of Cardiology/American Heart Association ACHD guidelines. Age-matching was used to account for baseline age differences between ACHD and non-ACHD patients.
E ACHD and 17 154 non-ACHD patients were identified. Without age-matching, ACHD patients were significantly younger than non-ACHD patients (mean age 38.5 vs 63.8 years). After age-matching (N = 805 in each group), mean age was 39.5 years in both groups. ACHD patients had less HMO (29.1% vs 34.7%, P = .012) and Medicaid (12.4% vs 17.3%, P = .006) coverage, but more PPO (34.4% vs 27.5%, P = .003) and Medicare (23.2% vs 18.1%, P = .005) coverage compared to non-ACHD patients. No differences were found in private insurance, public insurance, or self-pay. Lesion complexity had no effect on insurance in ACHD patients. Eligibility of parental plan coverage did not affect use of private insurance. ACHD patients in states with Medicaid expansion had higher rates of Medicaid (15.6% vs 10.6%, P = .045) but lower rates of HMO coverage (24.5% vs 31.7%, P = .036) and self-pay (0% vs 3.3%, P < .001). ACHD status, age, income, and residence in Medicaid expansion states were independent determinants of insurance types.
In the Affordable Care Act era, ACHD patients are a well-insured population. Governmental policy has substantial effects on individual-level choice and access to insurance.
先天性心脏病成人患者（ACHD）传统上被视为保险不足的人群。在《平价医疗法案》时代这是否属实尚不清楚。我们在一个当代队列中确定了ACHD患者与非ACHD心脏病学人群相比的保险模式。
回顾了2016年7月至2017年2月期间美国一家大型转诊中心的所有心脏病学门诊就诊情况。主要支付方被分类为健康维护组织（HMO）、优选提供者组织（PPO）、医疗保险、医疗补助、自费或其他。从ICD - 10诊断代码中提取ACHD的诊断和病变严重程度，并根据2008年美国心脏病学会/美国心脏协会ACHD指南进行分类。采用年龄匹配来考虑ACHD和非ACHD患者之间的基线年龄差异。
确定了E名ACHD患者和17154名非ACHD患者。在未进行年龄匹配时，ACHD患者明显比非ACHD患者年轻（平均年龄38.5岁对63.8岁）。年龄匹配后（每组N = 805），两组的平均年龄均为39.5岁。与非ACHD患者相比，ACHD患者的HMO（29.1%对34.7%，P = 0.012）和医疗补助（12.4%对17.3%，P = 0.006）覆盖范围较少，但PPO（34.4%对27.5%，P = 0.003）和医疗保险（23.2%对18.1%，P = 0.005）覆盖范围较多。在私人保险、公共保险或自费方面未发现差异。病变复杂性对ACHD患者的保险情况没有影响。父母保险计划覆盖的资格不影响私人保险的使用。在有医疗补助扩大计划的州，ACHD患者的医疗补助率较高（15.6%对10.6%，P = 0.045），但HMO覆盖率较低（24.5%对31.7%，P = 0.036）和自费率较低（0%对3.3%，P < 0.001）。ACHD状态、年龄、收入以及在有医疗补助扩大计划的州居住是保险类型的独立决定因素。
在《平价医疗法案》时代，ACHD患者是保险良好的人群。政府政策对个人层面的保险选择和获取有重大影响。
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