ArticleAnnals of family medicine2019
The Ecology of Medical Care Before and After the Affordable Care Act: Trends From 2002 to 2016.
Article in Annals of family medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Impact of the Affordable Care Act on Dental Care: An Integrative Literature Review.International journal of environmental research and public health · 2021Pooled it
- The Ecology of Medical Care in Shanghai: Temporal Trends and International Comparisons.Risk management and healthcare policy · 2025Article
- Measurement of breast artery calcification using an artificial intelligence detection model and its association with major adverse cardiovascular events.PLOS digital health · 2024Article
- Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort Study.Kidney medicine · 2022Article
- Primary Care: The Actual Intelligence Required for Artificial Intelligence to Advance Health Care and Improve Health.JMIR medical informatics · 2022Article
- Rural-Urban Disparities in Health Access Factors Over Time: Implications for Cancer Prevention and Health Equity in the Midwest.Health equity · 2022Article
- National Trends and Outcomes Associated With Presence and Type of Usual Clinician Among Older Adults With Multimorbidity.JAMA network open · 2021Article
- Trends in Total and Out-of-Pocket Expenditures for Visits to Primary Care Physicians, by Insurance Type, 2002-2017.Annals of family medicine · 2020Article
- Changes in Rates and Content of Primary Care Visits Within an Evolving Health Care System.Annals of family medicine · 2019Article
- Decreasing Use of Primary Care: A Repeated Cross-Sectional Study of MEPS 2007-2017.Annals of family medicineArticle
- An Evaluation of the Decline in Primary Care Physician Visits, 2010 to 2021.Journal of primary care & community healthArticle
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe initial ecology of medical care study was published in 1961, offering a framework by which to investigate individuals' contact with the medical system. We studied changes in the framework around the implementation of the Patient Protection and Affordable Care Act (ACA) within longer-term trends.
methodsThe 2002-2016 Medical Expenditure Panel Survey was used to determine rates of visit/contact per 1,000 individuals per month for physicians, primary care physicians, specialty physicians, emergency departments, inpatient hospitalizations, dental visits, and home health visits for the overall population and by age group, poverty category, health status, and race/ethnicity. Adjusted Wald tests were used to investigate differences between the pre-ACA (2012-2013) and post-ACA (2014-2015) periods. Multivariable linear regression was used to determine trends over the study period (2002-2016).
resultsThe survey included 525,804 person-years. The uninsured rate decreased from 12.8% (95% CI, 12.0%-13.7%) in 2013 to 7.6% (95% CI, 7.0%-8.3%) in 2016. From 2002 to 2016, the numbers of individuals in a month who had contact with primary care physicians, dental care, and inpatient hospitalizations decreased. Primary care physician contact decreased most among the elderly and those reporting fair/poor health. After ACA implementation, few significant changes were identified in the overall population or by age, poverty category, race/ethnicity, or health status.
conclusionsThe medical ecology framework was not notably altered 2 years after implementation of the ACA. The long-term decrease in primary care contact does not appear to have been interrupted after implementation of the ACA, was observed across income and age categories, and was most evident among the elderly and individuals reporting fair/poor health.
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