source: American Society of Hematology

year: 2016

authors: Wendy Darlington, Sydeaka P Watson, Tara O Henderson, John M Cunningham, Rena M Conti

Introduction: The Dependent Coverage Provision (DCP) of the 2010 Affordable Care Act aims to improve (1) access to medical care among individuals aged 18-25 nationwide and (2) the efficiency of care by increasing appropriate outpatient care and reducing avoidable inpatient care. Individuals became eligible for coverage under their parents’ private insurance in late September 2010. Previous studies have demonstrated improvement in access to care among those eligible for DCP, but no studies have examined the experience of young adults with serious disease requiring chronic medical care such as sickle cell disease (SCD). We hypothesized SCD patients aged 18-25 had increased access to commercial insurance, higher use of outpatient and lower use of inpatient care in the years following DCP implementation compared to patients ineligible for DCP.

Methods: This national analysis of patients aged 0-30 with qualifying SCD claims was performed using the Truven Health Analytics MarketScan Commercial Claims and Encounters dataset 2003-2013. The dataset contains commercial insurance claims of employees and dependants representing more than 50 million lives annually. We included patients with a continuous 12 month enrollment, and >1 inpatient or outpatient SCD claim in a given year. SCD claims included those with ICD-9 codes for homozygous SCD (HgbSS), sickle cell thalassemias (HgbSC, HgbSbo, HgbSb+) with and without crises, or splenic sequestration and/or acute chest syndrome. We defined 2003-2010 as pre-DCP and 2011-2013 as post-DCP. Inflation adjusted annual average per person spending, defined as reimbursements paid to providers, of SCD related inpatient and outpatient care was calculated. Descriptive statistics of number and share of patients by year and age cohort were calculated. Descriptive statistics of number of outpatient and inpatient claims by year and age cohort were calculated. A segmented regression analysis was performed to test for changes in trend of patient share by age cohort after the DCP. Access is defined as share of individuals having any claim type during the year. A difference-in-differences analysis was performed to study changes in medical care use and spending among individuals aged 18-25 pre and post-DCP, compared to those 26-30 and 12-17.

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