Affordable Care Act and Health Outcomes of People Living with HIV in Virginia

平价医疗法案和弗吉尼亚州艾滋病毒感染者的健康结果

• 批准号: 8983597
• 负责人: Kathleen Ann McManus
• 金额: $ 6.27万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8983597
• 关键词: Affordable; Care; Act; Health; Outcomes

 DESCRIPTION (provided by applicant): The Affordable Care Act (ACA) is federal legislature that aims to increase the number of people with health insurance and to improve health outcomes. People living with HIV (PLWH) are often uninsured or underinsured, and therefore are positioned to theoretically benefit from the ACA. Providing HIV medications to PLWH is beneficial to the individual for his longevity and to the public in terms of reduced HIV transmission. Before the ACA passage, state AIDS Drug Assistance Programs (ADAPs) were the safety net resource responsible for providing key medications, including antiretroviral therapy and opportunistic infection prophylaxis, to uninsured or underinsured PLWH. While called a safety net, state ADAPs serve over 193,000 PLWH nationally, and in 2013, it was estimated that about one-third of PLWH receiving HIV care accessed medications through ADAP. Approximately 80% of Virginia ADAP clients were eligible for ACA insurance plans, and with this opportunity, Virginia ADAP shifted its role to help enroll its clients in ACA insurance plans, and it is paying ACA monthly premiums, medication copayments, and deductibles, as this is the new avenue for its clients to receive key medications. The ACA needs to be examined to see how it is being implemented and to ensure that it is having its intended effects. Moreover, given that federal and state funding supports ADAP, it needs to be assessed whether good outcomes are achieved. This work will (1) characterize the demographic and systems-level differences between Virginia ADAP clients who were enrolled in ACA insurance plans and those who were eligible but were not enrolled during the 2013- 2014 enrollment process and (2) define the relationship between months enrolled in an ACA insurance plan and HIV outcomes. This research will utilize Virginia Department of Health statewide data to provide important information for state and federal policy. In addition to addressing these research aims, this fellowship will also include a rigorous training program of didactic course work and close research mentoring by senior health services researchers, health economists, clinical epidemiologists and biostatisticians. This NRSA fellowship training plan will allow me to advance as an investigator and successfully compete for a K series career development award. Findings about the implementation of ACA insurance enrollment and the ACA's effects on HIV outcomes will be significant contributions to the fields of health services research, health policy and HIV care. The research generated with this NRSA fellowship opportunity will inform state and federal level discussions of ACA enrollment and outcomes achieved with this new policy. In a time of constrained budgets, funds need to be allocated in a way to optimize enrollment and achieve the best health outcomes. Good HIV health outcomes have benefits to the individual as well as to society.

 描述（由申请人提供）：《平价医疗法案》(ACA) 是联邦立法机构，旨在增加拥有健康保险的人数并改善健康结果，艾滋病毒感染者 (PLWH) 往往没有保险或保险不足，因此受到影响。理论上，向 PLWH 提供 HIV 药物有利于个人的长寿，也有利于公众减少 HIV 传播。在 ACA 通过之前，国家艾滋病药物援助计划。 (ADAP) 是安全网资源，负责向未参保或参保不足的 PLWH 提供关键药物，包括抗逆转录病毒治疗和机会性感染预防。虽然被称为安全网，但州 ADAP 为全国超过 193,000 名 PLWH 提供服务，据估计，2013 年，大约三分之一接受 HIV 护理的 PLWH 通过 ADAP 获得药物 大约 80% 的弗吉尼亚 ADAP 客户符合资格。借此机会，Virginia ADAP 转变了角色，帮助其客户加入 ACA 保险计划，并每月支付 ACA 保费、药物共付额和免赔额，因为这是客户获得保险的新途径需要对 ACA 进行审查，以了解其实施情况并确保其达到预期效果。此外，鉴于联邦和州资金支持 ADAP，需要评估是否取得了良好成果。工作意愿(1) 描述参加 ACA 保险计划的弗吉尼亚 ADAP 客户与符合资格但在 2013-2014 年注册过程中未参加的弗吉尼亚 ADAP 客户之间的人口统计和系统级别差异，以及 (2) 定义参加 ACA 保险计划的月份之间的关系ACA 保险计划和艾滋病毒结果。这项研究将利用弗吉尼亚州卫生部的联邦数据，为州和联邦政策提供重要信息。除了解决这些研究目标外，该奖学金还将包括严格的教学课程和密切培训计划。高级卫生人员的研究指导这项 NRSA 奖学金培训计划将使我能够晋升为一名调查员，并成功竞争 K 系列职业发展奖。关于 ACA 保险登记的实施以及 ACA 对艾滋病毒结果的影响的调查结果。将为卫生服务研究、卫生政策和艾滋病毒护理领域做出重大贡献。通过该 NRSA 奖学金机会进行的研究将为州和联邦层面关于 ACA 注册和在这一新政策受到限制时取得的成果的讨论提供信息。预算、资金需要以优化入学率和实现最佳健康结果的方式分配。良好的艾滋病毒健康结果对个人和社会都有好处。