Health Policy Center, Urban Institute, Washington, District of Columbia.
JAMA Netw Open. 2023 Apr 3;6(4):e237455. doi: 10.1001/jamanetworkopen.2023.7455.
Many US adults report having post-COVID-19 condition (PCC), but little is known about their access to health care.
To estimate the association of PCC with access and affordability challenges among US adults aged 18 to 64 years.
DESIGN, SETTING, AND PARTICIPANTS: This survey study used data from the Health Reform Monitoring Survey, a probability-based internet survey conducted June 17 to July 5, 2022. Participants included a nationally representative sample of 9484 US adults ages 18 to 64 years drawn from the Ipsos KnowledgePanel.
Self-reported PCC was defined as experiencing symptoms more than 4 weeks after first having COVID-19 that were not explained by another condition or factor. Access and affordability outcomes included having a usual place of care; forgoing care in the past 12 months because of costs, difficulty finding clinicians, or difficulty using health insurance; having problems paying family medical bills in the past 12 months; and having past-due medical debt.
Of 19 162 panel members recruited for the survey, 9599 individuals completed the survey (completion rate, 50.1%) and 9484 respondents were included in the final analytic sample (4720 females [50.6%, weighted]; mean [SD] age, 41.0 [13.5] years). A total of 3382 respondents (36.4%; 95% CI, 34.7%-38.2%) reported ever being diagnosed with COVID-19, among whom, 833 respondents (22.5%; 95% CI, 20.9%-24.2%) reported currently having PCC. After adjustment for differences in demographic, health, and geographic characteristics, adults with PCC were more likely than 2549 adults with a COVID-19 diagnosis but no report of PCC and 6102 adults never diagnosed with COVID-19 to report unmet health care needs in the past 12 months because of the following challenges: costs (27.0%; 95% CI, 23.2%-30.7% vs 18.3%; 95% CI, 15.9%-20.7% and 17.5%; 95% CI, 15.4%-19.6%) and difficulties finding clinicians accepting new patients (16.4%; 95% CI, 14.3%-18.4% vs 10.1%; 95% CI, 8.8%-11.5% and 10.7%; 95% CI, 9.6%-11.8%), getting a timely appointment (22.0%; 95% CI, 19.3%-24.8% vs 14.4%; 95% CI, 13.2%-15.7% and 13.9%; 95% CI, 12.9%-14.8%), and getting health plan care authorization (16.6%; 95% CI, 14.6%-18.6% vs 10.8%; 95% CI, 9.6%-12.1% and 10.3%; 95% CI, 9.4%-11.2%) (P < .001 for all comparisons).
This study found that adults aged 18 to 64 years with PCC were more likely than other adults to have difficulty getting and paying for health care. These findings suggest that policies aimed at improving access and affordability may focus on accelerating development of treatments and clinical guidelines, training clinicians, and addressing insurance-related administrative and cost barriers.
许多美国成年人报告患有新冠病毒后疾病（PCC），但对于他们获得医疗保健的情况知之甚少。
评估 PCC 与 18 至 64 岁美国成年人获得医疗保健和支付能力挑战的关联。
设计、设置和参与者：本调查研究使用了健康改革监测调查的数据，这是一项基于概率的互联网调查，于 2022 年 6 月 17 日至 7 月 5 日进行。参与者包括来自 Ipsos KnowledgePanel 的一个具有全国代表性的 9484 名 18 至 64 岁的美国成年人样本。
自我报告的 PCC 定义为在首次感染 COVID-19 后超过 4 周出现症状，但无法用其他疾病或因素解释。获得医疗保健和支付能力的结果包括有一个常规的医疗场所；在过去 12 个月中，由于费用、难以找到临床医生或难以使用医疗保险而放弃医疗保健；在过去 12 个月中存在家庭医疗账单支付问题；以及存在逾期的医疗债务。
在招募的 19599 名面板成员中，有 9599 人完成了调查（完成率为 50.1%），9484 名受访者被纳入最终分析样本（4720 名女性[50.6%，加权]；平均[SD]年龄为 41.0[13.5]岁）。共有 3382 名受访者（36.4%；95%CI，34.7%-38.2%）报告曾被诊断患有 COVID-19，其中 833 名受访者（22.5%；95%CI，20.9%-24.2%）报告目前患有 PCC。在调整了人口统计学、健康和地理特征的差异后，与 2549 名有 COVID-19 诊断但无 PCC 报告的成年人和 6102 名从未被诊断患有 COVID-19 的成年人相比，患有 PCC 的成年人更有可能报告在过去 12 个月中因以下挑战而无法获得医疗保健：费用（27.0%；95%CI，23.2%-30.7% 与 18.3%；95%CI，15.9%-20.7%和 17.5%；95%CI，15.4%-19.6%）和难以找到接受新患者的临床医生（16.4%；95%CI，14.3%-18.4% 与 10.1%；95%CI，8.8%-11.5%和 10.7%；95%CI，9.6%-11.8%），以及获得及时预约（22.0%；95%CI，19.3%-24.8% 与 14.4%；95%CI，13.2%-15.7%和 13.9%；95%CI，12.9%-14.8%）和获得健康计划医疗授权（16.6%；95%CI，14.6%-18.6% 与 10.8%；95%CI，9.6%-12.1%和 10.3%；95%CI，9.4%-11.2%）（所有比较的 P 值均<.001）。
本研究发现，18 至 64 岁的成年人患有 PCC 比其他成年人更有可能在获得和支付医疗保健方面存在困难。这些发现表明，旨在改善获得和支付能力的政策可能侧重于加速开发治疗方法和临床指南、培训临床医生以及解决与保险相关的行政和费用障碍。
