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目的探讨平价医疗法案医疗补助计划范围扩大后,参与该保险的患者对社区卫生服务中心的需求是否更大。为了更好地了解新的医疗补助计划启动前后对社区卫生服务中心利用的变化,对2008年俄勒冈州随机医疗补助计划扩展试验(俄勒冈试验)进行研究。方法收集参与俄勒冈试验的成年人(19~64岁)数据,同时收集俄勒冈州108家参与OCHIN社区卫生信息网络(原为俄勒冈社区卫生信息网络)的社区卫生服务中心的电子健康数据进行概率性匹配,纳入人数为34 849例。使用零膨胀泊松回归模型进行意向性分析,比较参与医疗补助计划人群与未参与人群在36个月内的初级医疗使用率。采用辅助变量分析参与医疗补助计划保险对初级医疗利用的影响。结局包括初级医疗问诊、行为/心理问诊、实验室检查、转诊、免疫和影像检查。结果意向性分析显示,参与医疗补助计划人员与未参与医疗补助计划人员的行为/心理问诊率、转诊率和影像检查率间差异有统计学意义。工具性变量分析表明,参与医疗补助计划使初级医疗问诊率、实验室检查率、转诊率和影像检查率明显增加,其中实验室检查率增加最低,为1.27〔95%CI(1.05,1.55)〕,转诊率最高,为1.58〔95%CI(1.10,2.28)〕。结论平价医疗法案范围的扩大使更多患者参与医疗补助计划,社区卫生服务中心各种服务的使用也随之增加。为了增进主要卫生服务的可利用性,应保证卫生系统向社区卫生服务中心和其他初级医疗机构提供更多资源,以满足日益增长的需求。
Objective To explore whether the demand for community health service centers for patients participating in this insurance is even greater after the coverage of the Affordable Care Act Medical Assistance Scheme is expanded. In order to better understand the changes in the use of community health centers around the start of the new Medicaid program, a 2008 Oregon Randomized Medicaid Extension Trial (Oregon Trial) was conducted. Methods Data were collected for adults (ages 19-64) participating in Oregon trials and probabilistic matching of electronic health data from 108 Oregon community health centers participating in the OCHIN Community Health Information Network (formerly Oregon Community Health Information Network) , Enrolling 34,849 patients. The zero-expansion Poisson regression model was used to carry out the analysis of intentionality, and to compare the primary medical utilization rates within 36 months between the Medicaid and non-participating groups. The use of supplementary variables to analyze the impact of participation in Medicaid insurance on primary health care use. Outcomes include primary medical consultations, behavioral / psychological consultations, laboratory tests, referrals, immunizations and imaging examinations. Results Intentional analysis showed that there was a significant difference in the behavioral / psychological consultation rate, referral rate and imaging examination rate among those participating in the Medicaid program and those not participating in the Medicaid program. Instrumental variables analysis showed that participation in the Medicaid program significantly increased the primary medical examination, laboratory examination, referral and imaging examinations, with the lowest rate of laboratory examinations being 1.27 (95% CI (1.05, 1.55 )], The highest referral rate was 1.58 [95% CI (1.10,2.28)]. Conclusion The expanded coverage of the Affordable Care Act has increased the number of patients involved in Medicaid programs and the use of various services in community health centers has increased. To enhance the availability of key health services, health systems should be assured that additional resources are provided to community health centers and other primary health care providers to meet the growing needs.