Cardiology Division, Washington University School of Medicine, St. Louis, Missouri.
Cardiology Division, Washington University School of Medicine, St. Louis, Missouri.
JACC Heart Fail. 2019 Sep;7(9):737-745. doi: 10.1016/j.jchf.2019.04.021. Epub 2019 Aug 7.
The Affordable Care Act (ACA) and other major health care legislative acts have had an important impact on the care of heart failure patients in the United States. The main effects of the ACA include regulation of the health insurance industry, expansion of access to health care, and health care delivery system reform, which included the creation of several alternative payment models. Particular components of the ACA, such as the elimination of annual and lifetime caps on spending, Medicaid expansion, and the individual and employer mandate, could have positive effects for heart failure patients. However, the benefits of value-based and alternative payment models such as the Hospital Readmissions Reduction Program and bundled payment programs for heart failure outcomes are less clear, and controversy exists regarding whether some of these programs may even worsen outcomes. As the population ages and the prevalence of heart failure continues to rise, this syndrome will likely remain a key clinical focus for policymakers. Therefore, heart failure clinicians should be aware of how legislation affects clinical practice and be prepared to adapt to continued changes in health policy.
平价医疗法案（ACA）和其他主要的医疗保健立法法案对美国心力衰竭患者的护理产生了重要影响。ACA 的主要影响包括规范医疗保险行业、扩大医疗保健服务的可及性，以及医疗服务提供系统的改革，其中包括创建了几种替代支付模式。ACA 的一些特定内容，如取消年度和终身支出上限、扩大医疗补助计划以及个人和雇主的强制规定，可能对心力衰竭患者产生积极影响。然而，基于价值的和替代支付模式的好处，如医院再入院率降低计划和心力衰竭结局的捆绑支付计划，其效果则不太明确，而且对于这些计划是否会使某些结果恶化，还存在争议。随着人口老龄化和心力衰竭的患病率持续上升，这种综合征可能仍然是政策制定者的一个主要临床重点。因此，心力衰竭临床医生应该了解立法如何影响临床实践，并准备好适应医疗政策的持续变化。
