平价医疗法案保险市场对手术患者自付费用的影响。
Impact of the Affordable Care Act Insurance Marketplaces on Out-of-Pocket Spending Among Surgical Patients.
机构信息
S-SPIRE Center, Department of Surgery, Stanford University, Stanford, CA.
National Clinician Scholars Program, National Clinician Scholars Program, University of California, Los Angeles, CA.
出版信息
Ann Surg. 2021 Dec 1;274(6):e1252-e1259. doi: 10.1097/SLA.0000000000003823.
OBJECTIVE
To evaluate the association between the introduction of the Affordable Care Act (ACA) Health Insurance Marketplaces ("Marketplaces") and financial protection for patients undergoing surgery.
BACKGROUND
The ACA established Marketplaces through which individuals could purchase subsidized insurance coverage. However, the effect of these Marketplaces on surgical patients' healthcare spending remains largely unknown.
METHODS
We analyzed a nationally representative sample of adults aged 19-64 who underwent surgery in 2010-2017, using the Medical Expenditure Panel Survey. Low-income patients eligible for cost-sharing and premium subsidies in the Marketplaces [income 139%-250% federal poverty level (FPL)] and middle-income patients eligible only for premium subsidies (251%-400% FPL) were compared to high-income controls ineligible for subsidies (>400% FPL) using a quasi-experimental difference-in-differences approach. We evaluated 3 main outcomes: (1) out-of-pocket spending, (2) premium contributions, and (3) likelihood of experiencing catastrophic expenditures, defined as out-of-pocket plus premium spending exceeding 19.5% of family income.
RESULTS
Our sample included 5450 patients undergoing surgery, representing approximately 69 million US adults. Among low-income patients, Marketplace implementation was associated with $601 lower [95% confidence interval (CI): -$1169 to -$33; P = 0.04) out-of-pocket spending; $968 lower (95% CI: -$1652 to -$285; P = 0.006) premium spending; and 34.6% lower probability (absolute change: -8.3 percentage points; 95% CI: -14.9 to -1.7; P = 0.01) of catastrophic expenditures. We found no evidence that health expenditures changed for middle-income surgical patients.
CONCLUSIONS
The ACA's insurance Marketplaces were associated with improved financial protection among low-income surgical patients eligible for both cost-sharing and premium subsidies, but not in middle-income patients eligible for only premium subsidies.
目的
评估平价医疗法案（ACA）医疗保险市场的引入与接受手术患者的财务保障之间的关联。
背景
ACA 通过市场为个人提供补贴保险。然而，这些市场对手术患者的医疗支出的影响在很大程度上仍然未知。
方法
我们分析了 2010 年至 2017 年期间进行手术的 19-64 岁成年人的全国代表性样本，使用医疗支出面板调查。有资格获得市场中成本分担和保费补贴的低收入患者（收入为联邦贫困线的 139%-250%）和仅符合保费补贴资格的中等收入患者（251%-400% FPL）与不符合补贴资格的高收入对照组（>400% FPL）进行比较，使用准实验差分差异方法。我们评估了 3 个主要结果：（1）自付支出，（2）保费贡献，以及（3）发生灾难性支出的可能性，定义为自付支出加上保费支出超过家庭收入的 19.5%。
结果
我们的样本包括 5450 名接受手术的患者，代表了大约 6900 万美国成年人。在低收入患者中，市场的实施与自付支出减少 601 美元相关（95%置信区间：-1169 至-33；P = 0.04）；保费支出减少 968 美元（95%置信区间：-1652 至-285；P = 0.006）；灾难性支出的可能性降低 34.6%（绝对变化：-8.3 个百分点；95%置信区间：-14.9 至-1.7；P = 0.01）。我们没有发现中间收入手术患者健康支出发生变化的证据。
结论
ACA 的保险市场与有资格获得成本分担和保费补贴的低收入手术患者的财务保障改善有关，但与仅符合保费补贴资格的中等收入患者无关。
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