Illinois College of Optometry, Chicago, IL, United States of America.
SUNY College of Optometry, New York, NY, United States of America.
PLoS One. 2020 Nov 2;15(11):e0241475. doi: 10.1371/journal.pone.0241475. eCollection 2020.
To determine the impact of the Affordable Care Act (ACA) on utilization of benefits of both eye care and primary care examinations in individuals who did not have health insurance prior to the ACA.
Patients examined in an urban eye clinic from 2017 to 2018 were invited to participate. Patients were classified into two groups: Insured Group, who had health insurance before and after the ACA; The ACA Group, who had insurance only after the ACA. Patients were surveyed on how often they were examined by their eye care and primary care physicians before and after the ACA. The care utilization frequency was categorized into 3 levels: Frequent Care Use, Rare Care Use, and Never. To test the utilization of benefits frequency difference between two groups, the z-ratio was calculated.
A total of 4,355 patients were enrolled with 87.1% in the Insured Group and 12.9% in the ACA Group. After the ACA implementation, the percentage of "Frequent Care Use" of the eye care and primary care in the ACA Group patients significantly increased from 31.2% and 53.7% to 57.9% and 74.9%, respectively (P<0.001), but were significantly lower than those in the Insured Group (76.6% and 93.9%, P < 0.001).
The ACA significantly improved utilization of benefits of eye care and primary care for individuals in the ACA Group. Although improved, those patients who received health insurance through the ACA still had lower utilization of benefits than those in the Insured Group.
确定《平价医疗法案》（ACA）对在该法案实施前没有医疗保险的个人的眼科保健和初级保健检查的福利利用的影响。
邀请在城市眼科诊所接受检查的患者参加。患者分为两组：有保险组，在 ACA 前后都有医疗保险；ACA 组，仅在 ACA 后才有保险。对患者进行调查，询问他们在 ACA 前后多久接受一次眼科医生和初级保健医生的检查。将护理利用频率分为 3 个等级：频繁护理使用、罕见护理使用和从不使用。为了测试两组之间福利利用频率的差异，计算了 z 比。
共纳入 4355 例患者，其中 87.1%为有保险组，12.9%为 ACA 组。ACA 实施后，ACA 组患者的眼科和初级保健的“频繁护理使用”比例分别从 31.2%和 53.7%显著增加到 57.9%和 74.9%（P<0.001），但显著低于有保险组（76.6%和 93.9%，P<0.001）。
ACA 显著改善了 ACA 组个人的眼科保健和初级保健的福利利用。尽管有所改善，但那些通过 ACA 获得医疗保险的患者的福利利用率仍低于有保险组。
