实施健康行为激励型医疗补助扩张与传统医疗补助扩张后，覆盖范围、获得途径和健康状况的变化。
Changes in Coverage, Access, and Health Following Implementation of Healthy Behavior Incentive Medicaid Expansions vs. Traditional Medicaid Expansions.
机构信息
Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
出版信息
J Gen Intern Med. 2020 Sep;35(9):2521-2528. doi: 10.1007/s11606-020-05801-6. Epub 2020 Apr 1.
BACKGROUND
Several states expanded Medicaid under the Affordable Care Act using Section 1115 waivers to implement healthy behavior incentive (HBI) programs, but the impact of this type of expansion relative to traditional expansion is not well understood.
OBJECTIVE
To examine whether Medicaid expansion with healthy behavior incentive programs and traditional Medicaid expansion were associated with differential changes in coverage, access, and self-rated health outcomes among low-income adults.
DESIGN
Difference-in-differences analysis of American Community Survey and Behavioral Risk Factor Surveillance System data from 2011 to 2017.
PARTICIPANTS
Low-income adults ages 19-64 in the Midwest Census region (American Community Survey, n = 665,653; Behavioral Risk Factor Surveillance System, n = 71,959).
INTERVENTIONS
Exposure to either HBI waiver or traditional Medicaid expansion in the state of residence.
MAIN MEASURES
Coverage: Medicaid, private, or any health insurance coverage; access: routine checkup, personal doctor, delaying care due to cost; health: cancer screening, preventive care, healthy behaviors, self-reported health.
KEY RESULTS
Healthy behavior incentive (HBI) and traditional expansion (TE) states experienced reductions in uninsurance (- 5.6 [- 7.5, - 3.7] and - 6.2 [- 8.1, - 4.4] percentage points, respectively) and gains in Medicaid (HBI, + 7.6 [2.4, 12.8]; TE, + 9.7 [5.9, 13.4] percentage points) relative to non-expansion states. Both expansion types were associated with increases in rates of having a personal doctor (HBI, + 3.8 [2.0, 5.6]; TE, + 5.9 [2.2, 9.6] percentage points) and mammography (HBI, + 5.6 [0.6, 10.6]; TE, + 7.3 [0.7, 13.9] percentage points). Meanwhile, checkups increased more in HBI than in TE states (p < 0.01), but no other changes in health care services differed between expansion types.
CONCLUSIONS
Medicaid expansion was associated with improvements in coverage and access to care with few differences between expansion types.
背景
在平价医疗法案下，几个州通过第 1115 项豁免条款扩大了医疗补助计划，以实施健康行为激励（HBI）计划，但这种扩张类型与传统扩张的相对影响尚未得到很好的理解。
目的
研究医疗补助计划中是否存在健康行为激励计划的扩张以及传统医疗补助计划的扩张，与低收入成年人的覆盖范围、获得服务的机会和自我评估健康结果的变化之间是否存在差异。
设计
2011 年至 2017 年期间，对美国社区调查和行为风险因素监测系统数据进行差异中的差异分析。
参与者
中西部普查区（美国社区调查，n=665653；行为风险因素监测系统，n=71959）的 19-64 岁的低收入成年人。
干预措施
居住州的 HBI 豁免或传统医疗补助计划的暴露情况。
主要措施
覆盖范围：医疗补助、私人保险或任何健康保险覆盖范围；获得服务的机会：常规体检、私人医生、因费用而延迟治疗；健康状况：癌症筛查、预防保健、健康行为、自我报告的健康状况。
主要结果
健康行为激励（HBI）和传统扩张（TE）州的未参保率（HBI，-5.6[-7.5，-3.7]和-6.2[-8.1，-4.4]个百分点；TE，+9.7[5.9，13.4]个百分点）均有所下降，而医疗补助（HBI，+7.6[2.4，12.8]；TE，+9.7[5.9，13.4]个百分点）有所增加。与非扩张州相比，这两种扩张类型都与私人医生的比例增加有关（HBI，+3.8[2.0，5.6]；TE，+5.9[2.2，9.6]个百分点）和乳房 X 光检查率（HBI，+5.6[0.6，10.6]；TE，+7.3[0.7，13.9]个百分点）。与此同时，HBI 州的体检增加幅度大于 TE 州（p<0.01），但两种扩张类型之间的医疗服务变化没有其他差异。
结论
医疗补助计划的扩张与覆盖范围的改善和获得医疗服务的机会增加有关，扩张类型之间几乎没有差异。
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