Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
J Adolesc Health. 2019 Jun;64(6):763-769. doi: 10.1016/j.jadohealth.2018.12.004. Epub 2019 Mar 6.
Young adults have unique health and health care needs. Although morbidity and mortality stem largely from preventable factors, they lack a structured set of preventive care guidelines. The Affordable Care Act (ACA), enacted in 2010, increased young adult insurance coverage, prohibited copayments for preventive visits among privately insured and for many preventive services. The objectives were to evaluate pre- to post-ACA changes in young adults' past-year well visits and, among those using a past-year health care visit, the receipt of preventive services.
We used pooled Medical Expenditure Panel Survey data, comparing pre-ACA (2007-2009, N = 10,294) to post-ACA (2014-2016, N = 10,567) young adults aged 18-25 years. Bivariable and multivariable stratified logistic regression, adjusting for sociodemographic covariates, were conducted to determine differences in well visits and in preventive services among past-year health care utilizers: blood pressure and cholesterol checks, influenza immunization, and all three received.
Past-year well visits increased from pre-ACA (28%) to post-ACA (32%), p < .001. Increases were noted for most demographic subgroups with greatest increases among males, Asian, and highest income subgroups. Larger pre- to post-ACA increases were found for most of the preventive services, p < .05, including the receipt of all three services (7% vs. 16%), p < .001, among past-year health care utilizers.
Following ACA implementation, young adults experienced modest increases in well visit rates and larger increases in most preventive services received. Overall rates of both remain low. Building on these improvements requires concerted efforts that account for young adults' unique combination of health care issues and challenges in navigating an adult health care system.
年轻人有独特的健康和医疗保健需求。尽管发病率和死亡率主要源于可预防的因素，但他们缺乏一套结构化的预防保健指南。《平价医疗法案》（ACA）于 2010 年颁布，增加了年轻成年人的保险覆盖范围，禁止私人保险的预防就诊和许多预防服务的共付额。其目的是评估 ACA 实施前后年轻成年人过去一年的健康检查次数，以及在过去一年中使用医疗保健服务的人群中，预防服务的使用情况。
我们使用了合并的医疗支出面板调查数据，将 ACA 实施前（2007-2009 年，N=10294）与 ACA 实施后（2014-2016 年，N=10567）的 18-25 岁年轻成年人进行比较。采用双变量和多变量分层逻辑回归，调整社会人口学协变量，确定过去一年使用医疗服务的人群中健康检查和预防服务的差异：血压和胆固醇检查、流感免疫接种以及所有三种服务的接受情况。
过去一年的健康检查次数从 ACA 实施前的 28%增加到 ACA 实施后的 32%，p<0.001。大多数人口统计学亚组都有所增加，其中男性、亚裔和收入最高的亚组增幅最大。在大多数预防服务中，预 ACA 到后 ACA 的增加幅度更大，p<0.05，包括过去一年使用医疗服务的人群中所有三种服务的接受情况（7%对 16%），p<0.001。
ACA 实施后，年轻成年人的健康检查率略有增加，大多数预防服务的接受率也有所增加。总体而言，这两个比率仍然较低。要在这些改善的基础上进一步发展，需要做出协调一致的努力，解决年轻人独特的医疗保健问题，并应对他们在成人医疗保健系统中的挑战。
