Harvard College, Cambridge, Massachusetts.
University of California College of the Law, San Francisco.
JAMA Health Forum. 2024 Aug 2;5(8):e242640. doi: 10.1001/jamahealthforum.2024.2640.
By expanding health insurance to millions of people in the US, the Patient Protection and Affordable Care Act (ACA) may have important health, economic, and social welfare implications for people with criminal legal involvement-a population with disproportionately high morbidity and mortality rates.
To scope the literature for studies assessing the association of any provision of the ACA with 5 types of outcomes, including insurance coverage rates, access to care, health outcomes, costs of care, and social welfare outcomes among people with criminal legal involvement.
The literature search included results from PubMed, CINAHL Complete, APA Psycinfo, Embase, Social Science Database, and Web of Science and was conducted to include articles from January 1, 2014, through December 31, 2023. Only original empirical studies were included, but there were no restrictions on study design.
Of the 3538 studies initially identified for potential inclusion, the final sample included 19 studies. These 19 studies differed substantially in their definition of criminal legal involvement and units of analysis. The studies also varied with respect to study design, but difference-in-differences methods were used in 10 of the included studies. With respect to outcomes, 100 unique outcomes were identified across the 19 studies, with at least 1 in all 5 outcome categories determined prior to the literature search. Health insurance coverage and access to care were the most frequently studied outcomes. Results for the other 3 outcome categories were mixed, potentially due to heterogeneous definitions of populations, interventions, and outcomes and to limitations in the availability of individual-level datasets that link incarceration data with health-related data.
In this scoping review, the ACA was associated with an increase in insurance coverage and a decrease in recidivism rates among people with criminal legal involvement. Future research and data collection are needed to understand more fully health and nonhealth outcomes among people with criminal legal involvement related to the ACA and other health insurance policies-as well as the mechanisms underlying these relationships.
通过向美国数百万人扩大医疗保险范围，《患者保护与平价医疗法案》（ACA）可能会对有刑事法律涉入的人群产生重要的健康、经济和社会福利影响——这是一个发病率和死亡率极高的人群。
对文献进行研究范围界定，评估 ACA 的任何条款与 5 种结果之间的关联，包括保险覆盖范围、获得医疗服务的机会、健康结果、医疗成本和有刑事法律涉入人群的社会福利结果。
文献检索包括来自 PubMed、CINAHL Complete、APA Psycinfo、Embase、社会科学数据库和 Web of Science 的结果，并进行了检索，以纳入 2014 年 1 月 1 日至 2023 年 12 月 31 日期间的文章。仅纳入原始实证研究，但对研究设计没有限制。
在最初确定的 3538 项潜在纳入研究中，最终样本包括 19 项研究。这些 19 项研究在刑事法律涉入的定义和分析单位方面存在很大差异。这些研究在研究设计方面也存在差异，但纳入的 19 项研究中有 10 项使用了差异-差异方法。就结果而言，19 项研究共确定了 100 个独特的结果，其中至少有 1 个在文献检索前就确定了所有 5 个结果类别。健康保险覆盖范围和获得医疗服务的机会是最常研究的结果。其他 3 个结果类别的结果参差不齐，这可能是由于人群、干预措施和结果的定义存在差异，以及将监禁数据与健康相关数据联系起来的个人层面数据集的可用性有限。
在这项范围界定审查中，ACA 与有刑事法律涉入人群的保险覆盖范围增加和累犯率降低有关。需要进行未来的研究和数据收集，以更全面地了解与 ACA 和其他健康保险政策相关的有刑事法律涉入人群的健康和非健康结果，以及这些关系背后的机制。
