Impact of affordability on accessibility of medical care post affordable care act in the USA

摘要

Objectives Many people in the USA could not access required health care in a timely manner because of the lack of affordability. The Patient Protection and Affordable Care Act (PPACA) was implemented to increase access to medical care by improving affordability. The objective of this study was to assess the impact of affordability on accessibility of medical care after implementation of PPACA. Methods This cross-sectional study analysed data from the 2013 to 2014 National Health Interview Survey. The study included adults who experienced affordability problems. Logistic regression model, after adjusting for sociodemographic characteristics was used to assess impact of affordability on accessibility. Key findings A total of 45 865 individuals were included in the analysis. Majority were White people, women, had some insurance, were married and attended some college. Almost 59.40% had problems paying or were unable to pay any medical care, 17.87% could not pay medical bills over time and 23.62% respondents experienced difficulties to access because of worry about cost. Odds of difficulty to access was significantly higher (OR = 3.39, 95% CI = 3.19 to 3.61) for those with affordability issues compared to those without any problem. Ability to pay off bill over time decreased the difficulty to access (OR = 0.90, 95% CI = 0.85 to 0.96). Being uninsured, female, and unmarried, having poor health status, low income could significantly decrease the odds of access. Conclusions Lack of affordability adversely impacted accessibility of medical care even after implementation of PPACA. Increase in affordability through various policy measures is required to improve accessibility to medical care among vulnerable groups.