Han Jayoung, Ko Dongwoo
Pharmacy Practice, School of Pharmacy and Health Sciences, Fairleigh Dickinson University, 230 Park Avenue, M-SP1-01, Florham Park, NJ, 07932, USA.
Marketing, College of Business, Hankuk University of Foreign Studies, Seoul, South Korea.
BMC Health Serv Res. 2018 Jun 19;18(1):469. doi: 10.1186/s12913-018-3285-5.
The Affordable Care Act (ACA) established the health insurance marketplaces to provide people the opportunity to obtain healthcare coverage. Assisters have worked with people who may have difficulty understanding the new system and selecting the right plan. This study aims to describe the local availability of assister programs, and examine the factors influencing assister provision.
The 2016 Small Area Health Insurance Estimates data and a database of assister programs constructed using healthcare.gov were analyzed at the county level. Bivariate analysis by assister provision was performed to determine the differences between the two groups, and the hierarchical generalized linear model was used to examine the factors predicting assister availability.
The study analyzed 2260 counties nested within 35 states. Assister availability largely varied across counties and states. About half of the counties did not provide assisters at all, and the assister provision rate at state level ranged between 19 - 100%. Counties in metropolitan areas were more likely to provide assister programs than rural areas, and so were counties with higher adult uninsured rate or higher uninsured rate among the people with incomes between 138 - 400% of federal poverty level (FPL).
Despite the important role of in-person assistance in plan enrollment, no previous study has examined the local variability of assister program. Our study found a large geographical variation in assister availability, raising concerns about the disparity in access to assister service.
《平价医疗法案》（ACA）设立了医疗保险市场，为人们提供获得医疗保险的机会。协助者与那些可能难以理解新系统并选择合适计划的人合作。本研究旨在描述协助者项目在当地的可获得性，并探讨影响协助者提供服务的因素。
在县一级分析了2016年小区域健康保险估计数据以及使用医保网站（healthcare.gov）构建的协助者项目数据库。对是否提供协助者服务进行双变量分析以确定两组之间的差异，并使用分层广义线性模型来研究预测协助者可获得性的因素。
该研究分析了35个州内的2260个县。协助者的可获得性在各县和各州之间差异很大。约一半的县根本没有提供协助者，州一级的协助者提供率在19%至100%之间。大都市地区的县比农村地区更有可能提供协助者项目，收入在联邦贫困线（FPL）的138%至400%之间的成年人未参保率较高或未参保率较高的县也是如此。
尽管面对面协助在计划登记中发挥着重要作用，但之前没有研究考察过协助者项目在当地的差异。我们的研究发现协助者的可获得性存在很大的地理差异，这引发了对获得协助者服务方面差距的担忧。
