National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman).
Psychiatr Serv. 2019 Sep 1;70(9):765-771. doi: 10.1176/appi.ps.201800559. Epub 2019 May 29.
The objective of this study was to assess changes in health insurance coverage and mental health treatment among individuals with and without involvement in the criminal justice system after implementation of key provisions of the Affordable Care Act (ACA).
Data from the National Survey on Drug Use and Health were used to assess changes in coverage, mental health treatment, and payer between 2011-2013 and 2014-2017 for nonelderly adults (ages 19 to 64) with and without criminal justice involvement in the past year who reported serious psychological distress. Multivariable logistic regression was used to obtain adjusted estimates.
The weighted sample represented, on average, 2.0 million individuals with criminal justice involvement (total unweighted N=3,688) and 20.9 million without criminal justice involvement (total unweighted N=33,872) in each study year. Following implementation of the ACA's key provisions, health insurance coverage increased by 13.4 percentage points (95% CI=8.5-18.3) among individuals with past year criminal justice involvement and by 8.1 percentage points (95% CI=6.9-9.4) among those without. Receipt of any mental health treatment did not change significantly among individuals with criminal justice involvement (-3.4 percentage points [95% CI=-8.0 to 1.1]), whereas it increased significantly in the general population (2.2 percentage points [95% CI=0.4-3.9]).
Despite an increase in health insurance coverage for people with criminal justice involvement, there was no increase in mental health treatment following implementation of the ACA's key provisions. Health insurance coverage is necessary, but not sufficient, to expand access to mental health treatment for individuals involved in the criminal justice system.
本研究旨在评估《平价医疗法案》（ACA）主要条款实施后，有过或无犯罪司法系统涉入的个体的健康保险覆盖范围和心理健康治疗的变化。
使用全国毒品使用与健康调查的数据，评估了过去一年有过或无犯罪司法系统涉入且报告有严重心理困扰的非老年成年人（19 岁至 64 岁）在 2011-2013 年至 2014-2017 年期间的覆盖范围、心理健康治疗和支付方的变化。多变量逻辑回归用于获得调整后的估计值。
加权样本平均代表了 200 万有犯罪司法涉入的个体（总未加权 N=3688）和 2090 万无犯罪司法涉入的个体（总未加权 N=33872），每年各一次。在 ACA 主要条款实施后，过去一年有犯罪司法涉入的个体的健康保险覆盖率增加了 13.4 个百分点（95%置信区间：8.5-18.3），而无犯罪司法涉入的个体增加了 8.1 个百分点（95%置信区间：6.9-9.4）。有犯罪司法涉入的个体接受任何心理健康治疗的比例没有显著变化（-3.4 个百分点[95%置信区间：-8.0 至 1.1]），而在普通人群中则显著增加（2.2 个百分点[95%置信区间：0.4-3.9]）。
尽管有犯罪司法涉入的个体的健康保险覆盖率有所增加，但在 ACA 主要条款实施后，心理健康治疗并没有增加。健康保险覆盖范围是扩大有犯罪司法涉入的个体获得心理健康治疗的必要条件，但不是充分条件。
