Meltzer Kerry K, Chen Kevin, Zhang Christine, Zhou Susan, Long Theodore, Jimenez Jonathan
National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
J Gen Intern Med. 2025 Feb;40(2):430-436. doi: 10.1007/s11606-024-08983-5. Epub 2024 Aug 5.
In 2019, New York City (NYC) launched NYC Care (NYCC), a healthcare access program through NYC Health + Hospitals (H + H) for individuals who are ineligible for federally funded health insurance programs or cannot purchase insurance through the State Marketplace, predominantly undocumented individuals.
To examine the sociodemographic characteristics, healthcare use patterns, and chronic disease quality measures for diabetes mellitus (DM) and hypertension among NYCC patients compared with Medicaid patients seen at NYC H + H.
Observational study.
Adults aged 18 years and older enrolled in NYCC (N = 83,003) or Medicaid (N = 512,012) as of January 1, 2022. Patients were included if they had at least one visit between January 1, 2021, and December 31, 2021.
Sociodemographic characteristics, healthcare use patterns, and quality measures for DM and hypertension.
NYCC patients (n = 83,003) were, on average, older, more likely to be Hispanic with Spanish as their preferred language, had more comorbidities, and had more primary care (adjusted incidence rate ratio 2.75 [95% confidence interval 2.71, 2.80]) and specialty care (2.22 [2.17, 2.26]) visits compared to Medicaid patients (n = 512,012). Rates of emergency department visits were similar between the two groups (1.02 [1.00, 1.04]), but NYCC patients had relatively fewer hospitalizations (0.64 [0.62, 0.67]). NYCC patients with DM or hypertension had higher rates of having a documented hemoglobin A1c or blood pressure in 2022, respectively, and clinically similar rates of chronic disease control (mean difference in hemoglobin A1c - 0.05 [- 0.09, - 0.01] in patients with DM and mean difference in blood pressure - 0.38 [- 0.67, - 0.10]/ - 0.64 [- 0.82, - 0.46]) compared with Medicaid patients.
NYCC effectively enrolled a large number of uninsured participants and provided them with healthcare access similar to that of Medicaid patients. Future studies should evaluate the impact of NYCC enrollment on healthcare utilization and disease outcomes.
2019年，纽约市启动了“纽约关怀”（NYCC）项目，这是一项通过纽约市卫生与医院系统（H+H）为无资格参加联邦资助医疗保险项目或无法通过州医保市场购买保险的个人提供医疗服务的项目，主要针对无证移民。
比较NYCC患者与在纽约市H+H接受治疗的医疗补助患者的社会人口学特征、医疗使用模式以及糖尿病（DM）和高血压的慢性病质量指标。
观察性研究。
截至2022年1月1日，年龄在18岁及以上并参加NYCC（N = 83,003）或医疗补助（N = 512,012）的成年人。如果患者在2021年1月1日至2021年12月31日期间至少有一次就诊，则纳入研究。
社会人口学特征、医疗使用模式以及DM和高血压的质量指标。
与医疗补助患者（n = 512,012）相比，NYCC患者（n = 83,003）平均年龄更大，更有可能是西班牙裔且首选语言为西班牙语，合并症更多，接受初级保健（调整发病率比2.75 [95%置信区间2.71, 2.80]）和专科护理（2.22 [2.17, 2.26]）就诊的次数更多。两组的急诊科就诊率相似（1.02 [1.00, 1.04]），但NYCC患者的住院次数相对较少（0.64 [0.62, 0.67]）。患有DM或高血压的NYCC患者在2022年分别有记录的糖化血红蛋白或血压的比例更高，慢性病控制率在临床上相似（DM患者糖化血红蛋白的平均差异为 -0.05 [-0.09, -0.01]，高血压患者血压的平均差异为 -0.38 [-0.67, -0.10]/ -0.64 [-0.82, -0.46]）。
NYCC有效地招募了大量未参保参与者，并为他们提供了与医疗补助患者相似的医疗服务。未来的研究应评估NYCC参保对医疗利用和疾病结局的影响。
