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首页> 外文期刊>Inquiry: a journal of medical care organization, provision and financing >National and Regional Variation in Local Primary Care Physician Density Relative to the Uninsured and the Affordable Care Act
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National and Regional Variation in Local Primary Care Physician Density Relative to the Uninsured and the Affordable Care Act

机译：国家和区域初级保健医生密度相对于未保险和实惠的护理法案

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This study is the first to examine primary care physician (PCP) density relative to the uninsured at the local level prior to and after insurance expansion under the Affordable Care Act. Primary care physician density is associated with access to care, lower inpatient and emergency care, and primary care services. However, access to primary care among the uninsured may be limited due to inadequate availability of PCPs. Core-Based Statistical Area (CBSA) data from the Area Health Resource File were retrospectively examined before and after Medicaid expansion. Multiple logistic regressions were modeled for PCP density with predictor interaction effects for percentage uninsured, Medicaid expansion status, and US Census regions. Medicaid expansion CBSAs had significantly lower proportions of uninsured and higher PCP density compared with their nonexpansion counterparts. Nationally, increasing proportions of the uninsured were significantly associated with decreasing PCP density. Most notably, there is an expected 32% lower PCP density in Western Medicaid expansion areas with many uninsured (90th percentile) compared with those with few uninsured (10th percentile). Areas expanding Medicaid with greater proportions of people becoming insured postexpansion had significantly fewer PCPs. Areas with greater proportions of the uninsured may have reduced access to primary care due to the paucity of PCPs in these areas. Efforts to improve access should consider a lack of local PCPs as a limitation for ensuring accessible and timely care. Health care and policy leaders should focus on answers to improve the local availability of primary care clinicians in underserved communities.
机译：本研究是第一个在经济实惠护理法案下保险扩张之前和之后的局部保险医师（PCP）密度相对于局部一级的未保险。初级保健医生密度与护理，降低住院病人和紧急护理和初级保健服务有关。然而，由于PCP的可用性不足，可能限制未保险的初级保险。在医疗补助扩张之前和之后，回顾性地检查了来自地区健康资源文件的核心统计区域（CBSA）数据。对于PCP密度的多元逻辑回归，具有预测的互动效应，百分比未保险，医疗补助扩展状态和美国人口普查区。与非扩张性同行相比，医疗补助扩张CBSA显着降低了无保险的无保险和PCP密度的比例。全国性地，随着PCP密度的降低而增加，未保险的比例显着相关。最值得注意的是，与少数未保险的人（第10百分位数）相比，西医结合扩张区域中预计32％的PCP密度降低了西医结合扩张区域的PCP密度。扩展Medicaid的地区具有更大比例的人们被保险的未被保险的未被保险的曝光展开的PCP较少。由于这些区域中PCP的缺乏，具有更大比例的区域可能会降低初级保健的访问。改善访问的努力应考虑缺乏本地PCP作为确保可访问和及时护理的限制。医疗保健和政策领导者应专注于改善福置社区中初级保健临床医生本地可用性的答案。

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