Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
JCO Oncol Pract. 2021 Oct;17(10):e1603-e1613. doi: 10.1200/OP.21.00095. Epub 2021 Jul 13.
Since Affordable Care Act (ACA) implementation in 2014, studies have demonstrated gains in insurance coverage for cancer survivors < 65 years. We assessed the impact of ACA implementation on financial barriers to care by stratifying survivors at age 65 years, when individuals typically become Medicare-eligible.
We used data from respondents with cancer in the 2009-2018 National Health Interview Survey. We identified 21,954 respondents representing approximately 7.4 million survivors, who were then age-stratified at age 65 years. Survey responses regarding financial barriers to medical care and medications were analyzed, and age-stratified multivariable logistic regression modeling was performed, which evaluated the impact of ACA implementation on these measures, adjusted for demographic and socioeconomic variables.
After multivariable logistic regression, ACA implementation was associated with higher adjusted odds of Medicaid insurance (odds ratio [95% CI] 2.02 [1.72 to 2.36]; < .0001) and lower adjusted odds of no insurance (0.57 [0.48 to 0.68]; < .0001). Regarding financial barriers, ACA implementation was associated with lower adjusted odds of inability to afford medications (0.68 [0.59 to 0.79]; < .0001), inability to afford dental care (0.83 [0.73 to 0.94]; = .004), and delaying care (0.78 [0.69 to 0.89]; = .002) in the 18-64 years group. Similarly, ACA implementation was associated with lower adjusted odds of secondary outcomes such as delaying refills, skipping doses, and anxiety over medical bills. Similar associations were not seen in the > 65 years group.
Survivor-reported measures of financial barriers in cancer survivors age 18-64 years significantly improved following ACA implementation. Similar changes were not seen in the Medicare-eligible cohort, likely because of high Medicare enrollment and few uninsured.
自 2014 年平价医疗法案（ACA）实施以来，已有研究表明，65 岁以下癌症幸存者的保险覆盖率有所提高。我们通过分层 65 岁的幸存者来评估 ACA 实施对护理经济障碍的影响，因为个人通常在这个年龄达到医疗保险资格。
我们使用 2009 年至 2018 年国家健康访谈调查中患有癌症的受访者的数据。我们确定了 21954 名代表约 740 万幸存者的受访者，然后按年龄分为 65 岁以上的年龄组。分析了关于医疗保健和药物的经济障碍的调查回复，并进行了年龄分层多变量逻辑回归建模，评估了 ACA 实施对这些措施的影响，调整了人口统计学和社会经济变量。
经过多变量逻辑回归，ACA 实施与更高的调整后医疗补助保险的几率相关（优势比[95%置信区间]2.02[1.72 至 2.36]；<.0001），而没有保险的几率则较低（0.57[0.48 至 0.68]；<.0001）。关于经济障碍，ACA 实施与无法负担药物的几率较低相关（0.68[0.59 至 0.79]；<.0001），无法负担牙科保健的几率较低（0.83[0.73 至 0.94]；=.004），以及延迟护理的几率较低（0.78[0.69 至 0.89]；=.002），在 18-64 岁组中。同样，ACA 实施与次要结果（如延迟补充药物、跳过剂量和对医疗费用的焦虑）的调整后几率较低相关。在 65 岁以上的组中，没有观察到类似的关联。
在 ACA 实施后，18-64 岁癌症幸存者报告的财务障碍测量值显著改善。在符合医疗保险资格的队列中，没有看到类似的变化，这可能是因为医疗保险的高参保率和很少有未参保者。
