Department of Sociology and Lerner Center for Public Health Promotion and Population Health, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA.
Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA.
J Intellect Disabil Res. 2023 Dec;67(12):1270-1290. doi: 10.1111/jir.13037. Epub 2023 May 2.
Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access.
Using a pre-ACA 2011-2013 sample and a post-ACA implementation 2014-2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost.
The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow-up medical care and eyeglasses due to cost in the post-ACA years.
The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow-up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.
从历史上看，美国智障成年人（ID）的医疗保健获取机会比普通人群差。然而，《患者保护与平价医疗法案》（ACA）的实施可能减少了医疗保健获取方面的差距。
使用国家健康访谈调查数据中的 ACA 实施前（2011-2013 年）样本和 ACA 实施后（2014-2016 年）样本，我们研究了 ACA 的引入与 ID 成年人医疗保健获取之间的关系（N=623）。负二项回归模型用于检验 ACA 与放弃医疗服务总数之间的关联。二元逻辑回归用于探索 ACA 的实施是否与拥有医疗保险的可能性增加以及由于成本而放弃任何和特定医疗服务的可能性降低有关。
研究结果表明，ACA 的实施与由于成本而放弃医疗服务总数和任何服务的可能性降低有关。研究结果还表明，ACA 的实施与医疗保险覆盖范围的扩大以及 ID 成年人医疗保健、牙科保健、专科就诊和精神保健服务中因成本而放弃服务的次数减少有关。然而，ID 患者在 ACA 实施后的几年中，由于成本，仍然面临更高的放弃处方药、后续医疗护理和眼镜的风险。
研究结果表明，ACA 实施后，美国 ID 患者的医疗保健获取得到改善。然而，后续护理、眼镜和处方药获取方面的挑战仍然存在，需要政策解决方案，这些解决方案超出了 ACA 的规定。
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