Ercia Angelo, Le Nga, Wu Runguo
Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK.
Department of Health & Human Services, County of Marin, Marin, California, USA.
Arch Public Health. 2021 Jul 12;79(1):129. doi: 10.1186/s13690-021-00645-w.
The Affordable Care Act (ACA) provided an opportunity for millions of people in the U.S. to get coverage from the publicly funded Medicaid program or private insurance from the newly established marketplace. However, enrolling millions of people for health insurance was an enormous task. The aim of this review was to examine the strategies used to enroll people for health insurance and their effectiveness after implementing the ACA's coverage expansion.
The PRISMA Extension for Scoping Review (PRISMA-ScR) guided this review. Included studies were empirical studies that met the inclusion criteria and published between 2010 and 2020. Studies were searched mainly from two scholarly databases, CINAHL Plus and Medline (PubMed) using keyword searches. Hand searches from the references of selected journals were also performed. Content analysis was conducted by two authors in which codes were inductively developed to identify themes.
There were 2213 potential studies identified from the search, but 10 met the inclusion criteria. The research design of the studies varied. Two studies were randomized trials, one quasi-experimental trial, three mixed-methods, two qualitative and two quantitative. All studies focused on strategies used to inform and help people enroll for either Medicaid or private insurance from the marketplace. This review identified three key strategies used to help enroll people for coverage: 1) individual assistance; 2) community outreach; and 3) health education and promotion (HE&P).
Community-based organizations were likely to use a combination of the three strategies simultaneously to reach uninsured individuals and directly help them enroll for health insurance. Other organizations that aimed to reach a wider segment of the population used single strategies, such as community outreach or HE&P.
《平价医疗法案》（ACA）为美国数百万人提供了从公共资助的医疗补助计划获得保险或从新设立的市场购买私人保险的机会。然而，为数百万民众登记参加医疗保险是一项艰巨的任务。本综述的目的是研究在实施ACA的保险覆盖范围扩大后，用于为民众登记参加医疗保险的策略及其有效性。
本综述以《系统评价的PRISMA扩展》（PRISMA-ScR）为指导。纳入的研究为符合纳入标准且于2010年至2020年期间发表的实证研究。主要通过关键词搜索从两个学术数据库CINAHL Plus和Medline（PubMed）中检索研究。还对所选期刊的参考文献进行了手工检索。由两位作者进行内容分析，通过归纳法制定编码以识别主题。
通过检索共识别出2213项潜在研究，但有10项符合纳入标准。这些研究的研究设计各不相同。两项研究为随机试验，一项为准实验试验，三项为混合方法研究，两项为定性研究，两项为定量研究。所有研究都聚焦于用于告知和帮助民众登记参加医疗补助计划或从市场购买私人保险的策略。本综述确定了用于帮助民众登记参加保险的三项关键策略：1）个人协助；2）社区外展；3）健康教育与促进（HE&P）。
基于社区的组织可能会同时使用这三种策略的组合，以覆盖未参保人群并直接帮助他们登记参加医疗保险。其他旨在覆盖更广泛人群的组织则采用单一策略，如社区外展或健康教育与促进。
