Bustamante Arturo Vargas, Chen Jie
University of California Los Angeles, Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, United States of America.
University of Maryland, Department of Health Services Administration, College Park, Maryland, United States of America.
Rev Panam Salud Publica. 2018 Aug 27;42:e106. doi: 10.26633/RPSP.2018.106. eCollection 2018.
To examine short-term changes in perceived barriers to access to primary care before and after implementation of the Affordable Care Act (ACA) among adults in the United States of America.
The ACA was approved in 2010. We used the National Health Interview Survey (NHIS) for the years 2011-2014 to compare the main reported problems in accessing primary care among adult respondents in 2011-2013 (before implementation of mandatory ACA health insurance for individuals) and in 2014 (after that implementation). A multivariate logistic stepwise regression analysis was used to identify trends with primary care barriers.
We found that from 2010 through 2014, individuals were progressively less likely to report challenges to accessing care, such as having trouble finding a provider, getting accepted as new patients, and health care providers not accepting their health insurance. In addition, adults were less likely to report inconveniences linked to waiting times for an appointment and with provider's office hours.
Informing policymakers, providers, and system administrators about the short-term changes in perceived barriers to care offers a baseline for evaluating policies and programs linked to implementing the ACA, as well as assessing how prepared primary care networks were for the influx of newly insured patients. Nevertheless, the abolition of the ACA health insurance mandate through legislation approved in December 2017 has put into question whether patients' perceptions of improved access to care will be sustained in the future.
研究美国成年人在《平价医疗法案》（ACA）实施前后，获取初级医疗服务时所感知到的障碍的短期变化情况。
ACA于2010年获批。我们利用2011 - 2014年的国家健康访谈调查（NHIS），比较了2011 - 2013年（ACA对个人强制实施医疗保险之前）和2014年（实施之后）成年受访者在获取初级医疗服务方面主要报告的问题。采用多变量逻辑逐步回归分析来确定初级医疗服务障碍的趋势。
我们发现，从2010年到2014年，个人报告获取医疗服务存在困难的可能性逐渐降低，比如难以找到医疗服务提供者、难以被接纳为新患者以及医疗服务提供者不接受其医疗保险等。此外，成年人报告预约等待时间和医疗服务提供者办公时间带来不便的可能性也降低了。
向政策制定者、医疗服务提供者和系统管理者通报获取医疗服务时所感知到的障碍的短期变化情况，为评估与实施ACA相关的政策和项目以及评估初级医疗服务网络对新参保患者涌入的准备情况提供了一个基线。然而，2017年12月通过的立法废除了ACA医疗保险强制规定，这使得患者对改善获取医疗服务情况的看法在未来是否能够持续受到质疑。
