Interventions to Increase Affordable Care Act Marketplace Enrollment: A Systematic Review and Meta-Analysis.

IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Population Health Management Pub Date : 2024-06-01 Epub Date: 2024-09-05 DOI:10.1089/pop.2024.0091
Lizzie Martin, Andrew Feher, William Schultz, Elana Safran, Alison K Cohen
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Abstract

Over 10 million uninsured individuals are eligible for subsidized health insurance coverage through the Affordable Care Act (ACA) marketplaces, and millions more were projected to become eligible with the end of the federal COVID-19 Public Health Emergency in 2023. Individual studies on behaviorally informed interventions designed to encourage enrollment suggest that some are more effective than others. This study summarizes evidence on the efficacy of these interventions and suggests which administrative burdens might be most relevant for potential enrollees. Published and unpublished studies were identified through a systematic review of studies assessing the impact of behaviorally informed interventions on ACA marketplace enrollment from 2014 to 2022. Thirty-four studies comprising over 18 million participants were included (32 randomized controlled trials and 2 quasiexperimental studies). At the time of data extraction, 8 were published. Twenty-seven of the studies qualified for inclusion in a meta-analysis, which found that the average rate of enrollment was about 1 percentage point higher for those who received an intervention (0.009, P < 0.001), a 24% increase relative to control households; for every 1000 people who receive an intervention, that would correspond to about 9 additional enrollees. When stratifying by intervention intensity, support-based interventions increased enrollment by 2 percentage points (0.020, P = 0.004), while information-based interventions increased enrollment by 0.6 percentage points (0.006, P < 0.001). The meta-analysis found that behaviorally informed interventions can increase ACA marketplace enrollment. Interventions aimed at alleviating compliance costs by providing enrollment support were about three times as effective as information alone.

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提高《平价医疗法案》市场注册率的干预措施:系统回顾与元分析》。
通过《可负担医疗法案》(ACA)市场,超过 1,000 万名无保险者有资格获得补贴医疗保险,预计随着 2023 年联邦 COVID-19 公共卫生紧急状况的结束,还会有数百万人有资格获得补贴医疗保险。对旨在鼓励参保的行为知情干预措施的个别研究表明,有些干预措施比其他干预措施更有效。本研究总结了这些干预措施的有效性证据,并提出了哪些行政负担可能与潜在加入者最为相关。通过对 2014 年至 2022 年期间评估行为知情干预对《美国医疗保险法》市场注册影响的研究进行系统性回顾,确定了已发表和未发表的研究。共纳入 34 项研究,参与者超过 1,800 万人(32 项随机对照试验和 2 项准实验研究)。在提取数据时,8 项研究已经发表。其中 27 项研究符合纳入荟萃分析的条件,荟萃分析发现,接受干预的家庭的平均注册率要高出约 1 个百分点(0.009,P < 0.001),相对于对照家庭增加了 24%;每 1000 个接受干预的人,就相当于增加了约 9 个注册者。如果按干预强度分层,以支持为基础的干预可使加入人数增加 2 个百分点(0.020,P = 0.004),而以信息为基础的干预可使加入人数增加 0.6 个百分点(0.006,P < 0.001)。荟萃分析发现,行为知情干预可以提高《美国医疗保险法案》市场的注册率。旨在通过提供注册支持来降低合规成本的干预措施的效果大约是单纯信息干预的三倍。
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来源期刊
Population Health Management
Population Health Management 医学-卫生保健
CiteScore
4.10
自引率
4.00%
发文量
81
审稿时长
6-12 weeks
期刊介绍: Population Health Management provides comprehensive, authoritative strategies for improving the systems and policies that affect health care quality, access, and outcomes, ultimately improving the health of an entire population. The Journal delivers essential research on a broad range of topics including the impact of social, cultural, economic, and environmental factors on health care systems and practices. Population Health Management coverage includes: Clinical case reports and studies on managing major public health conditions Compliance programs Health economics Outcomes assessment Provider incentives Health care reform Resource management Return on investment (ROI) Health care quality Care coordination.
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