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Tytuł pozycji:

Insurance instability and use of emergency and office-based care after gaining coverage: An observational cohort study.

Tytuł:
Insurance instability and use of emergency and office-based care after gaining coverage: An observational cohort study.
Autorzy:
Shafer PR; Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, United States of America.
Dusetzina SB; Department of Health Policy, School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America.
Sabik LM; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
Platts-Mills TF; Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Stearns SC; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Trogdon JG; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Źródło:
PloS one [PLoS One] 2020 Sep 04; Vol. 15 (9), pp. e0238100. Date of Electronic Publication: 2020 Sep 04 (Print Publication: 2020).
Typ publikacji:
Journal Article; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Original Publication: San Francisco, CA : Public Library of Science
MeSH Terms:
Emergency Service, Hospital/*economics
Emergency Service, Hospital/*statistics & numerical data
Insurance Coverage/*statistics & numerical data
Primary Health Care/*economics
Primary Health Care/*statistics & numerical data
Adolescent ; Adult ; Cohort Studies ; Female ; Health Care Surveys ; Humans ; Male ; Middle Aged ; Patient Protection and Affordable Care Act ; Young Adult
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Entry Date(s):
Date Created: 20200904 Date Completed: 20201029 Latest Revision: 20201029
Update Code:
20240104
PubMed Central ID:
PMC7473517
DOI:
10.1371/journal.pone.0238100
PMID:
32886675
Czasopismo naukowe
Background: The Affordable Care Act led to improvements in reporting a usual source of care, but it is unclear whether patients are changing their usual source of care in response to coverage gains. We assess whether prior insurance instability is associated with changes in use of emergency and office-based care after the Marketplace and Medicaid expansion were introduced.
Methods: Our study draws from the 2013-14 Medical Expenditure Panel Survey, identifying a cohort of non-elderly adults with full-year health insurance coverage in 2014. We use linear and multinomial logistic regression to assess the relationship between insurance instability prior to 2014 (uninsured for 1-11 months, ≥12 months) and person-level changes in use of health care after gaining coverage (change in ED and office visits from 2013 to 2014) with continuously insured individuals serving as a comparison group.
Results: Being uninsured for at least one year prior to gaining full-year coverage in 2014 was associated with a 33% increase in ED visits (0.06 visits, p<0.01) and a 47% increase in office visits (1.10 visits, p<0.01), driven by those gaining public coverage. We found no evidence of substitution across settings in the short term, often a stated goal of expansion.
Conclusion: The long-term uninsured may have substantial health needs and pent-up demand for health care, seeing more physicians across multiple settings in the year after gaining coverage as they seek to get unmanaged conditions under control. Closing the gap in primary care use between the previously uninsured and those with health insurance coverage may help improve long-term health outcomes.
Competing Interests: The authors have declared that no competing interests exist.
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