Exploring Healthcare Needs and Service Options after the Implementation of the Affordable Care Act

Background/Purpose: The impacts of the Affordable Care Act (ACA) are potentially far reaching. The ACA created the expansion of Medicaid eligibility in some states, allowed individuals under the age of 26 to enroll on a parent’s plan and created the health insurance marketplace that resulted in subsidized private plans. More than 25 million Americans have gained healthcare coverage as a result. Limited research is available on the factors related to service options that impact access.

Previous studies used the Health Belief Model (HBM) to explain how people use health services.  Using constructs defined by the model (predisposing characteristics, enabling resources and need factors) this current study explores the main effects on healthcare options. The goal of this study is to answer the question: What HBM factors are associated with number of options to physical or mental health services?

Methods:We analyzed the fall 2014 Health Reform Monitoring System (HRMS) data.  This nationally representative probability based internet panel is funded by the Urban Institute, Ford Foundation and Robert Wood Johnson Foundation. The sample includes 8,427 adults, ages 18-64. Topics addressed in this survey include issues regarding health care status, access to health care, and the use of health care services.

Multinomial logistic regressions were used to identify factors associated with the number of healthcare options. Service options consist of three categories (none, single option, multiple options) based on a survey question, “is there a place that you usually go when you’re sick or need advice about your health.”  Predisposing factors include age, race and sexual orientation; enabling resources include respondent’s insurance, income and education status; and need factors include mental health and physical health symptoms.

Results: Results of the multinomial logistic regression showed being older, being a non-white, female gender and number of days of physical health symptoms positively predicted both single healthcare service option (vs. none) and multiple healthcare service options (vs. none or single option). Mental health symptoms and income positively predicted single healthcare service option (vs. none) and multiple options (vs. none), but such symptoms were not a significant predictor of multiple options (vs. single option).  Education positively predicted multiple healthcare service options compared to those with none or just single option. 

Conclusions and Implications: Overall, people who have more symptoms are more likely to use healthcare services. However, those with mental health symptoms did not use multiple service options. Implications from this study suggest increasing practice provisions and policies to address the gaps in healthcare service options, particularly for individuals with mental health symptoms. Considering people with increased mental health needs are more likely to report only a single healthcare service option confirms the importance of integrated healthcare.  Clearly the ACA has increased the number of people who have health care coverage however disparities in access remain. As the time elapses and the ACA remains in place, it is imperative to explore data as it becomes available to assess if service options increase.