Shippee Nathan D, Vickery Katherine D
University of Minnesota School of Public Health.
University of Minnesota Medical School.
Issue Brief (Commonw Fund). 2018 May 1;2018:1-10.
Access to health care, use of services, and patient outcomes can be complicated by many medical and nonmedical factors. People facing complex challenges such as mental illness, housing insecurity, or substance use, however, are not a homogeneous group; different individuals have different needs.
To understand the needs of people with very low income--no more than 75 percent of the federal poverty level--who enrolled in Medicaid under Minnesota’s expansion of the program prior to the Affordable Care Act.
The authors analyzed data on nondisabled, childless adults in the Minneapolis-St. Paul region who enrolled in Medicaid between 2011 and 2013.
Early Medicaid expansion enrollees in urban Minnesota were largely nonwhite, male, and unmarried and had low educational attainment. In this very poor population, rates of homelessness, substance use, and mental illness were very high. More than 25 percent of adults dealt with two or more of these challenges, while 10 percent experienced all three. Providing access to a range of highly integrated health and social services may be the best way to help these individuals.
获得医疗保健服务、使用服务以及患者治疗结果可能会受到许多医学和非医学因素的影响而变得复杂。然而，面临诸如精神疾病、住房无保障或药物使用等复杂挑战的人群并非同质化群体；不同个体有不同需求。
了解在《平价医疗法案》之前明尼苏达州扩大医疗补助计划时登记加入医疗补助计划的收入极低（不超过联邦贫困线的75%）人群的需求。
作者分析了2011年至2013年期间在明尼阿波利斯 - 圣保罗地区登记加入医疗补助计划的非残疾、无子女成年人的数据。
明尼苏达州城市地区早期登记加入医疗补助计划的人群主要是非白人、男性且未婚，教育程度较低。在这个非常贫困的人群中，无家可归、药物使用和精神疾病的发生率非常高。超过25%的成年人面临两种或更多这些挑战，而10%的人同时经历了所有三种挑战。提供一系列高度整合的健康和社会服务可能是帮助这些人的最佳方式。
