University of Michigan, Institute for Healthcare Policy & Innovation, Ann Arbor, Michigan.
University of Michigan, Center for Health and Research Transformation, Ann Arbor, Michigan.
Ann Fam Med. 2021 Nov-Dec;19(6):484-491. doi: 10.1370/afm.2712. Epub 2021 Sep 13.
Persons with disabilities often experience uncoordinated health care, with repeated out-of-pocket copays. One purpose of the Patient Protection and Affordable Care Act (ACA) was to create zero copays for preventive health care including an annual wellness visit (AWV). The purpose of this study was to document the use of AWVs by persons with physical disabilities during the ACA rollout.
An administrative claims database, including both Medicare Advantage (MA) and commercial (COM) payers from 2008 to 2016, was used to identify unique wellness visits for adults with physical disabilities. We used interrupted time series analysis to compare AWV use by insurance type, sex, disability type, and race over time.
The proportion of zero copays provided a timeline of ACA implementation categorized as pre-ACA, ACA-implementation, and post-ACA periods. By 2016, AWV use maximized at 47.6% (95% CI, 44.7%-50.8%) among COM-insured White women with congenital disabilities. By 2016, the lowest AWV use reached one-half the maximum, at 21.6% (95% CI, 18.4%-25.2%) among COM-insured Hispanic men with acquired disabilities. MA-insured Black and Hispanic men with acquired disabilities reached similarly low levels of AWV use.
The ACA mandated zero copays, thereby allowing persons with physical disabilities the option for preventive health care without cost. Insurance type and sex significantly influenced AWV use, followed by disability type and race. Gaps in AWV use were exposed by insurance type, sex, disability, and race for persons with disabilities. Gaps in AWV use were also exposed between the general population and persons with disabilities..
残疾人经常经历不协调的医疗保健，反复自付共付额。《患者保护与平价医疗法案》（ACA）的目的之一是为包括年度健康检查（AWV）在内的预防保健创造零共付额。本研究的目的是记录在 ACA 推出期间，身体残疾人士对 AWV 的使用情况。
使用行政索赔数据库，包括 2008 年至 2016 年的医疗保险优势（MA）和商业（COM）支付者，以确定身体残疾成年人的独特健康检查。我们使用中断时间序列分析来比较不同保险类型、性别、残疾类型和种族随时间对 AWV 使用的影响。
根据 ACA 实施的时间线，零共付额的比例分为 ACA 实施前、ACA 实施中和 ACA 实施后三个时期。到 2016 年，COM 保险的白人女性先天性残疾者的 AWV 使用比例最高，达到 47.6%（95%CI，44.7%-50.8%）。到 2016 年，COM 保险的西班牙裔男性后天性残疾者的 AWV 使用比例最低，仅为最高值的一半，为 21.6%（95%CI，18.4%-25.2%）。MA 保险的黑人男性和西班牙裔男性后天性残疾者的 AWV 使用比例也较低。
ACA 要求零共付额，从而使身体残疾人士有机会获得免费的预防保健。保险类型和性别对 AWV 使用的影响最大，其次是残疾类型和种族。保险类型、性别、残疾和种族对残疾人士的 AWV 使用情况暴露了差距。AWV 使用差距也暴露了普通人群和残疾人士之间的差距。
