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首页> 外文期刊>BMC Health Services Research >Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act
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Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act

机译：根据《平价医疗法案》，在社区卫生中心的医疗补助和未投保患者中获得医疗服务

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The Affordable Care Act expanded Medicaid and increased federal funding for Community Health Centers (CHCs). To examine the role of Medicaid coverage on care patterns for those with available safety net care, we assessed differences in access to care for CHC patients with continuous Medicaid coverage vs. gaps in insurance coverage in the last year. We used data on adult respondents from the 2014 Health Center Patient Survey (N?=?1720) with continuous Medicaid coverage vs. those with some period without insurance coverage in the last 12?months. We examined reported need for any medical care, mental health care, prescription drugs, dental care, and referrals for care outside of the CHC in the last 12?months, and reports of being delayed or unable to get needed care by insurance status. We used logistic regression to assess the association between insurance status and care access, adjusting for patient characteristics. Patients with insurance gaps and continuous Medicaid coverage reported similar levels of need for most types of care in the last 12?months, but those with insurance gaps were significantly more likely to report having difficulty obtaining medical care, prescription drugs, dental care, and completing outside referrals. Of those with incomplete referrals for care outside of the CHC, patients with insurance gaps were more likely than those with continuous Medicaid to cite cost or insurance-related reasons for not following up (70% vs. 19%, p??0.01). Having continuous Medicaid coverage appeared to mitigate barriers to care for CHC patients compared to having intermittent or no insurance coverage over the last year. Policies that increase disruptions in Medicaid coverage could adversely impact access to care, even among those with available safety net care.
机译：《平价医疗法案》扩大了医疗补助计划，并增加了对社区卫生中心（CHC）的联邦资助。为了检查医疗补助覆盖率对具有可用安全网护理的患者的护理模式的作用，我们评估了连续接受医疗补助覆盖的CHC患者在获得护理方面的差异与去年保险覆盖率的差距。我们使用了2014年健康中心患者调查（N？=？1720）中具有连续医疗补助覆盖率的成年人受访者数据，以及过去12个月中有一段时间没有保险覆盖率的成年人受访者数据。我们检查了过去12个月内报告的任何需要的医疗保健，心理保健，处方药，牙科保健以及在CHC之外进行转诊的需求，以及报告是否因保险状况而延迟或无法获得所需的护理。我们使用逻辑回归来评估保险状况与医疗服务之间的关联，并根据患者特征进行调整。有保险缺口和持续医疗补助覆盖的患者在过去12个月中对大多数类型的护理的需求水平相似，但有保险缺口的患者更有可能报告难以获得医疗护理，处方药，牙科护理和完成外部推荐。在CHC之外没有得到完整转诊的患者中，有保险缺口的患者比那些持续进行医疗补助的患者更愿意提及费用或与保险相关的原因而不进行跟进（70％比19％，p≤0.01）。 。与过去一年间断断续续或没有保险的情况相比，连续的医疗补助覆盖率似乎减轻了对CHC患者的护理障碍。增加医疗补助覆盖范围中断的政策可能会对获得医疗服务产生不利影响，即使在那些拥有安全网医疗服务的政策中也是如此。

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