Goldstein Evan V, Cai Jie, Liu Anqi
Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA.
College of Public Health, The Ohio State University, Columbus, OH, USA.
Health Serv Insights. 2018 Jul 25;11:1178632918790880. doi: 10.1177/1178632918790880. eCollection 2018.
This article examines the initial effect of Affordable Care Act (ACA) Health Insurance Marketplace (Exchange) insurance on access to care among employed beneficiaries in a highly populated US state. Does Exchange insurance lead to better/worse health care access for employed beneficiaries, compared with similar individuals covered through standard employer-sponsored insurance (ESI) coverage? This retrospective study uses data from the 2015 Ohio Medicaid Assessment Survey, a dual-frame and computer-assisted telephone survey administered by the Ohio Colleges of Medicine Graduate Resource Center, the Ohio Department of Medicaid, the Ohio Department of Health, and Ohio State University, in conjunction with RTI International. This study examines a sub-sample of employed adults (age 18-64) covered by either an Exchange plan or ESI, extracted from the full sample of = 42 876. We use linear propensity score matching using Euclidean distance to balance treatment groups and logistic regression models to estimate the treatment effect of Exchange coverage on all outcome variables. McNemar tests, Rosenbaum sensitivity analysis, and Benjamini-Hochberg procedure adjustments are also conducted. Compared with ESI insurance, Exchange insurance has no significant effect on outcomes measuring either perceived access to care or, more specifically, perceived financial barriers to accessing care. Exchange plan viability remains a hot topic of debate across the United States, given the potential repeal of the individual mandate. We use risk-adjustment methods to demonstrate that Exchange plan beneficiaries do not experience worse access to care than ESI beneficiaries. That said, several key limitations are discussed.
本文探讨了《平价医疗法案》（ACA）医疗保险市场（交易所）保险对美国人口密集大州在职受益人的医疗服务可及性的初步影响。与通过标准雇主赞助保险（ESI）覆盖的类似个体相比，交易所保险是否会使在职受益人获得更好或更差的医疗服务？这项回顾性研究使用了2015年俄亥俄医疗补助评估调查的数据，该调查是由俄亥俄医学院研究生资源中心、俄亥俄医疗补助部、俄亥俄卫生部和俄亥俄州立大学联合RTI国际公司进行的双框架计算机辅助电话调查。本研究考察了从42876人的完整样本中抽取的由交易所计划或ESI覆盖的在职成年人（年龄18 - 64岁）子样本。我们使用欧几里得距离的线性倾向得分匹配来平衡治疗组，并使用逻辑回归模型来估计交易所覆盖对所有结果变量的治疗效果。还进行了麦克尼马尔检验、罗森鲍姆敏感性分析和本雅明尼 - 霍奇伯格程序调整。与ESI保险相比，交易所保险对衡量感知医疗服务可及性或更具体地说对感知医疗服务获取的财务障碍的结果没有显著影响。鉴于个人强制参保规定可能被废除，交易所计划的可行性仍是美国各地争论的热门话题。我们使用风险调整方法来证明交易所计划受益人的医疗服务可及性并不比ESI受益人差。话虽如此，但也讨论了几个关键限制因素。
