Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Department of General Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado.
JAMA Health Forum. 2024 Jul 5;5(7):e242014. doi: 10.1001/jamahealthforum.2024.2014.
Transitions in insurance coverage may be associated with worse health care outcomes. Little is known about insurance stability for individuals with opioid use disorder (OUD).
To examine insurance transitions among adults with newly diagnosed OUD in the 12 months after diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study using data from the Massachusetts Public Health Data Warehouse. The cohort includes adults aged 18 to 63 years diagnosed with incident OUD between July 1, 2014, and December 31, 2014, who were enrolled in commercial insurance or Medicaid at diagnosis; individuals diagnosed after 2014 were excluded from the main analyses due to changes in the reporting of insurance claims. Data were analyzed from November 10, 2022, to May 6, 2024.
Insurance type at time of diagnosis (commercial and Medicaid).
The primary outcome was the cumulative incidence of insurance transitions in the 12 months after diagnosis. Logistic regression models were used to generate estimated probabilities of insurance transitions by insurance type and diagnosis for several characteristics including age, race and ethnicity, and whether an individual started medication for OUD (MOUD) within 30 days after diagnosis.
There were 20 768 individuals with newly diagnosed OUD between July 1, 2014, and December 31, 2014. Most individuals with newly diagnosed OUD were covered by Medicaid (75.4%). Those with newly diagnosed OUD were primarily male (67% in commercial insurance, 61.8% in Medicaid). In the 12 months following OUD diagnosis, 30.4% of individuals experienced an insurance transition, with adjusted models demonstrating higher transition rates among those starting with Medicaid (31.3%; 95% CI, 30.5%-32.0%) compared with commercial insurance (27.9%; 95% CI, 26.6%-29.1%). The probability of insurance transitions was generally higher for younger individuals than older individuals irrespective of insurance type, although there were notable differences by race and ethnicity.
This study found that nearly 1 in 3 individuals experience insurance transitions in the 12 months after OUD diagnosis. Insurance transitions may represent an important yet underrecognized factor in OUD treatment outcomes.
保险覆盖范围的转变可能与更差的医疗保健结果有关。对于患有阿片类药物使用障碍（OUD）的个人的保险稳定性知之甚少。
在诊断后 12 个月内，研究新诊断为 OUD 的成年人的保险转换情况。
设计、设置和参与者：使用马萨诸塞州公共卫生数据仓库的数据进行的纵向队列研究。该队列包括 2014 年 7 月 1 日至 2014 年 12 月 31 日期间新诊断为 OUD 的 18 至 63 岁成年人，在诊断时参加商业保险或医疗补助；由于保险索赔报告的变化，2014 年后被诊断出的人被排除在主要分析之外。数据于 2022 年 11 月 10 日至 2024 年 5 月 6 日进行分析。
诊断时的保险类型（商业和医疗补助）。
主要结果是诊断后 12 个月内保险转换的累积发生率。使用逻辑回归模型，根据年龄、种族和民族以及个体是否在诊断后 30 天内开始使用治疗 OUD 的药物（MOUD）等几个特征，生成按保险类型和诊断划分的保险转换的估计概率。
在 2014 年 7 月 1 日至 2014 年 12 月 31 日期间，有 20768 人新诊断出 OUD。大多数新诊断为 OUD 的人都参加了医疗补助（75.4%）。新诊断为 OUD 的人主要是男性（商业保险中为 67%，医疗补助中为 61.8%）。在 OUD 诊断后的 12 个月内，有 30.4%的人经历了保险转换，调整后的模型显示，与商业保险（27.9%；95%CI，26.6%-29.1%）相比，从医疗补助开始的人（31.3%；95%CI，30.5%-32.0%）转换率更高。无论保险类型如何，年轻个体的保险转换概率通常高于年长个体，但种族和民族之间存在显著差异。
本研究发现，近 1/3 的人在 OUD 诊断后 12 个月内经历保险转换。保险转换可能是 OUD 治疗结果的一个重要但尚未被认识到的因素。
