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Titre du document / Document title

Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization

Auteur(s) / Author(s)

HOFER Adam N. (1) ; ABRAHAM Jean Marie (1) ; MOSCOVICE Ira (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) University of Minnesota, ETATS-UNIS

Résumé / Abstract

Context: Provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) expand Medicaid to all individuals in families earning less than 133 percent of the federal poverty level (FPL) and make available subsidies to uninsured lower-income Americans (133 to 400 percent of FPL) without access to employer-based coverage to purchase insurance in new exchanges. Since primary care physicians typically serve as the point of entry into the health care delivery system, an adequate supply of them is critical to meeting the anticipated increase in demand for medical care resulting from the expansion of coverage. This article provides state-level estimates of the anticipated increases in primary care utilization given the PPACA's provisions for expanded coverage. Methods: Using the Medical Expenditure Panel Survey, this article estimates a multivariate regression model of annual primary care utilization. Using the model estimates and state-level information regarding the number of uninsured, it predicts, by state, the change in primary care visits expected from the expanded coverage. Finally, the article predicts the number of primary care physicians needed to accommodate this change in utilization. Findings: This expanded coverage is predicted to increase by 2019 the number of annual primary care visits between 15.07 million and 24.26 million. Assuming stable levels of physicians' productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase. Conclusions: The PPACA's health insurance expansion parameters are expected to significantly increase the use of primary care. Two strategies that policymakers may consider are creating stronger financial incentives to attract medical school students to primary care and changing the delivery of care in ways that lead to operational improvements, higher throughput, and better quality of care.

Revue / Journal Title

The Milbank quarterly    ISSN  0887-378X   CODEN MIQUES 

Source / Source

2011, vol. 89, no1, pp. 69-89 [21 page(s) (article)] (1 p.1/2)

Langue / Language

Anglais

Editeur / Publisher

Wiley, Hoboken, NJ, ETATS-UNIS  (1986) (Revue)

Mots-clés anglais / English Keywords

Quality

;

Cost

;

Patient

;

Physician

;

Social security cover

;

Health insurance

;

Health system

;

Low income

;

Health Care

;

United States Of America

;

Mots-clés français / French Keywords

Qualité

;

Coût

;

Malade

;

Médecin

;

Couverture sociale

;

Assurance maladie

;

Système de santé

;

Faible revenu

;

Soin médical

;

Etats-Unis

;

Mots-clés espagnols / Spanish Keywords

Seguro de enfermedad

;

Localisation / Location

INIST-CNRS, Cote INIST : 24077, 35400019288431.0030

Nº notice refdoc (ud4) : 24090631



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