PDF(Pubmed)
Abstract：
Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of hospitals and physicians in these types of population health activities, much less is known about the role health insurers may play. We used data from the National Longitudinal Survey of Public Health Systems for the period 2006 to 2018 to examine trends in health insurer participation in population health activities and in the multi-sector collaborative networks that support these activities. We also used a difference-in-differences approach to examine the impact of Medicaid expansion on insurer participation in population health networks. Insurer participation increased in our study period both in the delivery of population health activities and in the integration into collaborative networks that support these activities. Insurers were most likely to participate in activities focusing on community health assessment and policy development. Results from our adjusted difference-in-differences models showed variation in association between insurer participation in population health networks and Medicaid expansion (Table 2). Population health networks in expansion states experienced significant increases insurer participation in assessment (4.48 percentage points, P < .05) and policy and planning (7.66 percentage points, P < .05) activities. Encouraging insurance coverage gains through policy mechanisms like Medicaid expansion may not only improve access to healthcare services but can also act as a driver of insurer integration into population health networks.
摘要：
医疗保健组织越来越多地参与活动，以识别和解决患者中健康的社会决定因素（SDOH），以改善健康结果并降低成本。虽然迄今为止的几项研究都集中在医院和医生在这些类型的人口健康活动中不断发展的作用上，人们对健康保险公司可能扮演的角色知之甚少。我们使用2006年至2018年国家公共卫生系统纵向调查的数据，研究了健康保险公司参与人口健康活动和支持这些活动的多部门合作网络的趋势。我们还使用了差异差异方法来研究医疗补助扩展对保险公司参与人口健康网络的影响。在我们的研究期间，保险公司在提供人口健康活动以及融入支持这些活动的协作网络方面的参与都有所增加。保险公司最有可能参加以社区健康评估和政策制定为重点的活动。我们调整后的差异模型的结果表明，保险公司参与人口健康网络与医疗补助扩展之间的关联存在差异（表2）。扩张州的人口健康网络经历了保险公司参与评估的显着增加（4.48个百分点，P<.05)和政策和规划(7.66个百分点，P<.05)活动。通过扩大医疗补助等政策机制来鼓励保险覆盖率，不仅可以改善获得医疗保健服务的机会，而且还可以作为保险公司融入人口健康网络的驱动力。
