Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA.
J Behav Health Serv Res. 2024 Jan;51(1):57-73. doi: 10.1007/s11414-023-09861-4. Epub 2023 Sep 6.
This study examines whether the Affordable Care Act (ACA) Medicaid expansion (ME) was associated with changes in racial/ethnic disparities in insurance coverage, utilization, and quality of mental health care among low-income adults with probable mental illness using the National Survey on Drug Use and Health with state identifiers. This study employed difference-in-difference models to compare ME states to non-expansion states before (2010-2013) and after (2014-2017) expansion and triple difference models to examine these changes across non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Latino racial/ethnic subgroups. Insurance coverage increased significantly for all racial/ethnic groups in expansion states relative to non-expansion states (DD: 9.69; 95% CI: 5.17, 14.21). The proportion low-income adults that received treatment but still had unmet need decreased (DD: -3.06; 95% CI: -5.92, -0.21) and the proportion with unmet need and no mental health treatment increased (DD: 2.38; 95% CI: 0.03, 4.73). ME was not associated with reduced disparities.
本研究使用具有州标识符的全国药物使用与健康调查，考察了平价医疗法案（ACA）医疗补助扩大（ME）是否与低收⼊患有可能精神疾病的成年人的保险覆盖范围、利用和精神卫生保健质量的种族/民族差异的变化有关。本研究采用差分模型比较了扩⼤ME 的州与非扩⼤州在扩⼤之前（2010-2013 年）和扩⼤之后（2014-2017 年）的差异，并采用三重差分模型检验了这些变化在非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和西班牙裔/拉丁裔种族/民族亚组中的情况。与非扩⼤州相比，扩⼤ ME 的州所有种族/民族群体的保险覆盖范围显著增加（DD：9.69；95%CI：5.17，14.21）。接受治疗但仍有未满足需求的低收⼊成年人的比例下降（DD：-3.06；95%CI：-5.92，-0.21），⽽未满足需求且没有接受精神卫生治疗的成年人的比例增加（DD：2.38；95%CI：0.03，4.73）。ME 与减少差异⽆关。
