Inequalities in hospitalizations for ambulatory care sensitive conditions in New York City before and after the affordable care act

• Published in: World medical and health policy 2023-12, Vol.15 (4), p.324-335
• Main Authors: Gusmano, Michael K., Weisz, Daniel, Rodwin, Victor G.
• Format: Article
• Language: English
• Subjects: Affordable Care Act; Ambulance service; Ambulatory care; Ciudad de Nueva York; Desigualdad; Ethnicity; Expenditures; Health care industry; Health insurance; Hospitalization; Income inequality; inequality; Insurance coverage; Law; Ley del Cuidado de Salud a Bajo Precio; Medicaid; New York City; Patient Protection & Affordable Care Act 2010-US; Poverty; Presidents; Social inequality; Wealth; 《平价医疗法案》，纽约市，不平等
• ISSN: 1948-4682; 2153-2028; 1948-4682
• DOI: 10.1002/wmh3.548

The Patient Protection and Affordable Care Act (ACA) was signed into law by U.S. President Obama in 2010 and fully implemented in 2014. The ACA expanded health insurance by expanding the Medicaid program, creating health insurance exchanges (now called “marketplaces”) in which people with incomes between 139% and 400% of the federal poverty level, could purchase subsidized insurance coverage, and by regulating health insurance to eliminate practices such as denying coverage to people with pre‐existing conditions, or basing premiums on health status. We investigate the effects of the ACA's implementation on access to ambulatory health services in New York City by comparing rates of hospitalizations for ambulatory care‐sensitive conditions (ACSC) before and after the full implementation of the law. Although the ACA was associated with a significant decrease in the rate of ACSC in NYC, we find that there continue to be systemic inequalities by gender, race, ethnicity, income, and insurance status. We argue that the broader social and economic inequalities at the national and state levels, including tax and spending policies that have led to increased income and wealth inequalities, help explain why we see persistent inequalities in hospitalizations for ACSC. 摘要 《患者保护与平价医疗法案》(ACA)于2010年由奥巴马总统签署，并于2014年全面实施。ACA通过以下方式扩大健康保险扩大医疗补助计划、创造医疗保险市场（其中收入在联邦贫困线的139%到400%之间的人可以购买有补贴的保险）、通过监管健康保险以消除诸如拒绝向身患疾病的人提供保险或根据健康状况制定保费等做法。通过比较ACA全面实施前后的门诊护理敏感条件(ACSC)住院率，我们调查了ACA的实施对纽约市门诊护理服务获取的影响。尽管ACA与纽约市ACSC住院率的显著下降有关，但我们发现，性别、种族、族群性、收入和保险状况仍然存在系统性不平等。我们论证认为，国家和各州层面的更广泛的社会不平等与经济不平等（包括一系列加剧收入和财富不平等的税收政策和支出政策），有助于解释为何我们在ACSC住院治疗情况中发现持续的不平等。 Resumen La Ley de Protección al Paciente y Cuidado de Salud Asequible (ACA, por sus siglas en inglés) fue promulgada por el presidente Obama en 2010 e implementada por completo en 2014. La ACA amplió el seguro médico al expandir el programa Medicaid, creando intercambios de seguros médicos (ahora llamados “mercados”) en que las personas con ingresos entre el 139 y el 400 por ciento del nivel federal de pobreza podrían comprar cobertura de seguro subsidiado y al regular el seguro de salud para eliminar prácticas como negar cobertura a personas con condiciones preexistentes o basar las primas en el estado de salud. Investigamos los efectos de la implementación de la ACA en el acceso a los servicios de salud ambulatorios en la ciudad de Nueva York al comparar las tasas de hospitalizaciones por condiciones sensibles a la atención ambulatoria (ACSC) ant