Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.
J Gen Intern Med. 2021 Jun;36(6):1673-1681. doi: 10.1007/s11606-020-06552-0. Epub 2021 Feb 2.
Patient ratings of their healthcare experience as a quality measure have become critically important since the implementation of the Affordable Care Act (ACA). The ACA enabled states to expand Medicaid eligibility to reduce uninsurance nationally. Arkansas gained approval to use Medicaid funds to purchase a qualified health plan (QHP) through the ACA marketplace for newly eligible beneficiaries.
We compare patient-reported satisfaction between fee-for-service Medicaid and QHP participants.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) was used to identify differences in Medicaid and QHP enrollee healthcare experiences. Data were analyzed using a regression discontinuity design.
Newly eligible Medicaid expansion participants enrolled in Medicaid during 2013 completed the Consumer Assessment of Health Providers and Systems (CAHPS) survey in 2014. Survey data was analyzed for 3156 participants (n = 1759 QHP/1397 Medicaid).
Measures included rating of personal and specialist provider, rating of all healthcare received, and whether the provider offered to communicate electronically. Demographic and clinical characteristics of the enrollees were controlled for in the analyses.
Regression-discontinuity analysis was used to evaluate differential program effects on positive ratings as measured by the CAHPS survey while controlling for demographic and health characteristics of participants.
Adjusted logistic regression models for overall healthcare (OR = 0.71, 95%CI = 0.56-0.90, p = 0.004) and personal doctor (OR = 0.68, 95%CI = 0.53-0.87, p = 0.002) predicted greater satisfaction among QHP versus Medicaid participants. Results were not significant for specialists or for use of electronic communication with provider.
Using a quasi-experimental statistical approach, we were able to control for observed and unobserved heterogeneity showing that among participants with similar characteristics, including income, QHP participants rated their personal providers and healthcare higher than those enrolled in Medicaid. Access to care, utilization of care, and healthcare and health insurance literacy may be contributing factors to these results.
自平价医疗法案（ACA）实施以来，患者对医疗保健体验的评价作为一项质量衡量标准变得至关重要。ACA 使各州能够扩大医疗补助资格，以减少全国范围内的未参保人数。阿肯色州获得批准，可使用医疗补助资金通过 ACA 市场为新符合条件的受益人购买合格的健康计划（QHP）。
我们比较了按服务计费的医疗补助和 QHP 参与者的患者报告满意度。
使用医疗保健提供者和系统消费者评估（CAHPS）来确定医疗补助和 QHP 参保者医疗体验的差异。使用回归不连续性设计分析数据。
2013 年新符合医疗补助扩大条件的参与者在医疗补助中注册，并于 2014 年完成医疗保健提供者和系统消费者评估（CAHPS）调查。对 3156 名参与者（n = 1759 QHP/1397 医疗补助）的调查数据进行了分析。
措施包括对个人和专科医生的评分、对所有接受的医疗保健的评分以及医生是否提供电子沟通。在分析中控制了参保者的人口统计学和临床特征。
使用回归不连续性分析评估了差异化计划对 CAHPS 调查中积极评分的影响，同时控制了参与者的人口统计学和健康特征。
调整后的总体医疗保健（OR = 0.71，95%CI = 0.56-0.90，p = 0.004）和个人医生（OR = 0.68，95%CI = 0.53-0.87，p = 0.002）的逻辑回归模型预测 QHP 参与者比医疗补助参与者更满意。对于专科医生或与医生进行电子沟通的使用，结果不显著。
使用准实验统计方法，我们能够控制观察到和未观察到的异质性，表明在具有相似特征（包括收入）的参与者中，与参加医疗补助的参与者相比，QHP 参与者对他们的个人医生和医疗保健的评价更高。获得医疗保健的机会、使用医疗保健的情况以及医疗保健和健康保险的知识水平可能是造成这些结果的因素。
