Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, USA.
Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA.
Drug Alcohol Depend. 2018 Dec 1;193:124-130. doi: 10.1016/j.drugalcdep.2018.08.028. Epub 2018 Oct 6.
The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of newly enrolled patients with SUD in a large healthcare delivery system differed pre- and post- ACA implementation.
In this mixed-methods study, qualitative interviews were conducted with health system leaders to identify themes regarding how the health system prepared for the ACA. Electronic health record data were used to examine demographics, as well as specific SUD, psychiatric, and medical diagnoses in cohorts of pre-ACA (2012, n = 6066) vs. post-ACA (2014, n = 7099) newly enrolled patients with SUD. Descriptive statistics and logistic regression models were employed to compare pre-ACA and post-ACA measures.
Interviewees felt much uncertainty, but anticipated having to care for more SUD patients, who might have greater severity. Quantitative findings affirmed these expectations, with post-ACA SUD patients having higher rates of cannabis and amphetamine use disorders, and more psychiatric and medical conditions, compared to their pre-ACA counterparts. The post-ACA SUD cohort also had more Medicaid patients and greater enrollment in high-deductible plans.
Post-ACA, SUD patients had more comorbidities as well as and more financial barriers to care. As federal healthcare policy continues to evolve, with potentially more restrictive coverage criteria, it is essential to continue examining how health systems adapt to changing health policy and its impact on SUD care.
平价医疗法案（ACA）为扩大物质使用障碍（SUD）患者的保险覆盖范围提供了前所未有的机会。我们探讨了利益攸关方对 ACA 对 SUD 护理影响的期望，并研究了在大型医疗保健提供系统中，新纳入的 SUD 患者的临床特征在 ACA 实施前后的差异。
在这项混合方法研究中，对卫生系统领导人进行了定性访谈，以确定卫生系统为 ACA 做准备的主题。使用电子健康记录数据检查了预先（2012 年，n=6066）和之后（2014 年，n=7099）新纳入 SUD 患者的人口统计学特征，以及特定的 SUD、精神科和医疗诊断。采用描述性统计和逻辑回归模型比较了 ACA 前后的措施。
受访者感到非常不确定，但预计将不得不照顾更多的 SUD 患者，这些患者可能病情更严重。定量研究结果证实了这些预期，与 ACA 前患者相比，ACA 后 SUD 患者的大麻和苯丙胺使用障碍发生率更高，精神科和医疗状况更多。与 ACA 前患者相比，ACA 后 SUD 患者中 Medicaid 患者更多，参加高免赔额计划的人数也更多。
ACA 后，SUD 患者的合并症更多，获得医疗服务的经济障碍也更多。随着联邦医疗保健政策的不断演变，可能会有更严格的覆盖标准，因此，必须继续研究医疗系统如何适应不断变化的医疗政策及其对 SUD 护理的影响。
