Beyond ACA Enrollment Figures: Assessing Access to Care
Do we really know whether the Affordable Care Act (ACA) is achieving the intended triple aim of improving access to care, improving health care quality and lowering costs, while avoiding unintended consequences that affect patient care? In a column published in the April 2015 issue of Clinical Therapeutics, NPC’s Chief Science Officer, Robert W. Dubois, MD, PhD, outlines the challenges faced by researchers and policymakers in measuring the law’s actual impact. In particular, Dr.
Do we really know whether the Affordable Care Act (ACA) is achieving the intended triple aim of improving access to care, improving health care quality and lowering costs, while avoiding unintended consequences that affect patient care? In a column published in the April 2015 issue of Clinical Therapeutics, NPC’s Chief Science Officer, Robert W. Dubois, MD, PhD, outlines the challenges faced by researchers and policymakers in measuring the law’s actual impact. In particular, Dr. Dubois raises the importance of assessing changes in patient access and clinical care, identifies challenges in making those assessments and suggests actions that could be taken to address hurdles.
While news articles and other reports regularly highlight the number of people who have signed up for insurance through the federal and state health exchanges, Dr. Dubois notes that access to coverage cannot be measured solely by the number of Americans covered by health insurance policies. It also is important to assess the financial barriers to care that the newly insured may face under exchange-purchased plans, he suggests. For example, are high deductibles and coinsurance rates creating barriers to care? Are people with insurance skipping doctor’s visits or not filling their prescriptions because of those barriers?
It’s also important to have the right data to conduct these kinds of assessments, he says. Today there are disparate databases that are not able to track individual patients to compare outcomes within periods before and after the insurance exchanges took effect, making it hard to assess whether the newly insured are receiving value in health care. Tools also are needed in order to evaluate whether pay-for-performance models for providers are resulting in underuse of treatments or redressing previous issues of overuse, he suggests.
There is more work to be done, however, and objective research-based study of the law’s impact will be most beneficial to improving the health system in the long run. Dr. Dubois concludes, “We hope that the ACA is achieving the desired intended consequences and is avoiding the most worrisome unintended ones. Assessing the ACA’s impact is critical to achieving the aims of better health, improved health care, and lower costs and to avoiding the alternatives of worse health, deteriorating quality of care, and rising costs.”