Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states.
Background and Aims: Impoverished people who inject drugs (PWID) are at the epicenter of US drug‐related epidemics. Medicaid expansion is designed to reduce cost‐related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study a...
| Publicado en: | Addiction Vol. 119; no. 3; pp. 582 - 593 |
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| Autores principales: | , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Mar2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=175229188&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 175229188 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09652140 AIO jtl: Addiction issn: 09652140 maglogo: Y pubinfo: dt: Mar2024 vid: 119 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 175229188 174008499 175229188 175229188 10.1111/add.16383 175229188 ppf: 582 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states. aug: au: Cooper, Hannah Beane, Stephanie Yarbrough, Courtney Haardörfer, Regine Ibragimov, Umed Haley, Danielle Linton, Sabriya Beletsky, Leo Landes, Sarah Lewis, Rashunda Peddireddy, Snigdha Sionean, Catlainn Cummings, Janet affil: Department of Behavioral, Social, and Health Education Sciences, Rollins Chair of Substance Use Disorder Research, Rollins School of Public Health at Emory University, Atlanta GA,, USA sug: subj: Medicaid Expansion Insurance, Health Substance Use Disorders Therapy Persons Who Use Intravenous Drugs Indigent Persons Health Services for the Indigent Health Services Needs and Demand Health Services Accessibility Human Male Female United States Cross Sectional Studies Nonexperimental Studies Centers for Disease Control and Prevention (U.S.) Descriptive Statistics Comparative Studies Confidence Intervals Health Care Costs Overdose Substance Use Disorders Epidemiology Adolescence Adult Middle Age Aged Socioeconomic Disparities in Health Funding Source Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background and Aims: Impoverished people who inject drugs (PWID) are at the epicenter of US drug‐related epidemics. Medicaid expansion is designed to reduce cost‐related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line. Design: A two‐way fixed‐effects model was used to analyze serial cross‐sectional observational data. Setting: Seventeen metro areas in 13 US states took part in the study. Participants: Participants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS), were aged ≤ 64 years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD. Measurements State‐level Medicaid expansion was measured using Kaiser Family Foundation data. Individual‐level self‐report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation). Findings The sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two‐thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage‐point increase in the probability of insurance coverage, and a 9.0 (95% CI = −15.0, −0.2) percentage‐point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584). Conclusions: US Medicaid expansion may curb drug‐related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non‐financial barriers may undermine expansion's impact upon substance use disorder treatment in this sample. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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