| Healthcare Program/Policy Evaluation | The Impact of the Affordable Care Act (ACA) on diabetes care |
| Description | |
| How was the success of the program or policy measured? | The ACA is the most significant healthcare-related legislation in the USA since Medicare’s establishment in 1966. According to Furmanchuk et al. (2021), the ACA included provisions to address quality, cost, access to health insurance coverage, and the expansion of health coverage to more Americans. However, in relation to diabetes care, the success of this policy was measured based on a variety of parameters such as diabetic diagnostics and management, access to care, and improvement in the quality of care. Diabetic diagnostics was assessed through screening programs to detect undiagnosed diabetes. On the other hand, access to care was measured through insured visits by both diabetic and prediabetic patients (Furmanchuk et al., 2021). Meanwhile, diabetic management and quality of care were measured using the level of control of biomarkers such as HbA1c values, Medicaid expenditures, and access to medications.
|
| How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? | The policy targeted Americans with preexisting diabetes, prediabetics, and the undiagnosed.According to Myerson et al. (2019), approximately 37.3 million people in the US have diabetes, a value that correlates to 28.7 million diagnosed and 8.5 million undiagnosed. Similarly, Myerson et al. (2019) estimate another 96 million people as prediabetic. Consequently, the ACA policy targeted all these individuals. The exact comprehensive evaluation of the impact of the ACA on diabetes care is yet to be done. Nonetheless, the existing studies reveal the following effects of ACA on diabetes care. ACA led to the expansion of Medicare services in several states by advocating for coverage of preexisting illnesses.
Luo et al. (2019), in their study, observed that the health insurance coverage for people with diabetes increased in both Medicaid expansion and non-expansion states with a larger increase in Medicaid expansion states (P < .05, adjusted odds ratio [AOR] = 1.43, 95% confidence interval: 1.04-1.96). Consequently, residents in expansion states were more likely to afford physician visits, annual checkups, and personal doctor. Similarly, Marino et al. (2020), observed a reduction in adjusted mean HbA1c levels (8.24% [67 mmol/mol] to 8.17% [66 mmol/mol]) among insured compared to uninsured whose HbA1c levels increased (8.12% [65 mmol/mol] to 8.29% [67 mmol/mol]; difference-in-differences [DID] −0.24%; P < 0.001). The newly insured under the ACA also showed greater reductions in systolic blood pressure and LDL levels compared to the uninsured. Myerson et al. (2019) found that an additional 1.9 million people, 1.2 million of whom had low income, gained health insurance after ACA implementation. However, Furmanchuk et al. (2021) detected an insignificant increase of 0.21 (95% CI −2.10 to 2.52) in the prescription for diabetes medications among low-income persons after the implementation of ACA, although this study attributed its findings to confounding variables such as all prescription measures instead of per enrollee measures. Finally, concerning cost, Furmanchuk et al. (2021) established that a reduction in cost following the implementation of ACA remains an arguable achievement as the out-of-pocket payments decreased while Medicare expenditures increased significantly.
|
| At what point in program implementation was the program or policy evaluation conducted? | The Center for Consumer Information and Insurance Oversight (CCIIO) is tasked with the assistance of the implementation of numerous reforms of the ACA. Following implementation, the policy has to be evaluated to determine its progress or success and whether changes should be made. This was done by Post Affordable Care Act Evaluation (PACE), a case-control observational study sponsored by Oregon Health and Science University, prospective in nature, that began in Jan 2012 and was completed on October 24, 2018. The study recruited 1939848 participants and spanned through initial implementation, full implementation, and expansion and scale-up stages of program implementation. However, several other studies have evaluated the impact of ACA on the US healthcare system and focused on distinct paramet
Online class and exam helpStruggling with online classes or exams? Get expert help to ace your coursework, assignments, and tests stress-free! |