Pre- and Post-Affordable Care Act Visit/Contact Rates and Long-Term Trends
| Overall Population | Pre (2012-2013) | Post (2014-2015) | Difference | P Value | Rate of Change (per Year, 2002-2016) | P Value |
|---|---|---|---|---|---|---|
| Physician | 187 (179-196) | 190 (181-199) | 3 (−2 to 7) | .24 | −1.2 (−1.5 to –0.9) | <.001 |
| Primary care physician | 102 (97-106) | 103 (98-108) | 1 (−2 to 4) | .41 | −1.2 (−1.4 to –1.0) | <.001 |
| Specialty physician | 103 (98-109) | 106 (100-111) | 2 (−2 to 6) | .26 | −0.1 (−0.4 to 0.1) | .3 |
| Emergency department | 15 (15-16) | 16 (15-17) | 1 (0-2) | .04 | 0 (0-0.1) | .46 |
| Inpatient hospitalization | 7 (7-8) | 7 (6-7) | 0 (−1 to 0) | .18 | −0.1 (−0.1 to –0.1) | <.001 |
| Dental | 67 (64-71) | 70 (66-74) | 2 (0-4) | .035 | −0.7 (−0.9 to –0.5) | <.001 |
| Home health visit | 11 (9-12) | 13 (12-14) | 2 (1-3) | .001 | 0.1 (0-0.2) | .06 |
| Age Category | ||||||
| Age <18 Years | ||||||
| Physician | 146 (140-151) | 146 (141-150) | 0 (−6 to 6) | .99 | −0.5 (−0.9 to –0.1) | .03 |
| Primary care physician | 110 (106-114) | 113 (109-117) | 3 (−2 to 8) | .24 | −0.6 (−1.1 to –0.3) | .001 |
| Specialty physician | 42 (39-45) | 38 (36-41) | −4 (−7 to –1) | .05 | 0.1 (−0.1 to 0.4) | .31 |
| Emergency department | 12 (11-13) | 12 (11-13) | 0 (−1 to 1) | .92 | −0.1 (−0.2 to 0) | .03 |
| Inpatient hospitalization | 3 (2-3) | 2 (2-2) | −1 (−1 to 0) | .002 | 0 (−0.1 to 0) | .05 |
| Dental | 82 (78-86) | 85 (81-89) | 3 (−2 to 8) | .22 | −0.3 (−0.7 to –0.1) | .16 |
| Home health visit | 4 (2-5) | 4 (3-5) | 0 (−1 to 1) | .99 | 0.2 (0.1-0.3) | <.001 |
| Age ≥18 & ≤40 Years | ||||||
| Physician | 125 (121-129) | 121 (116-126) | −4 (−10 to 2) | .16 | −1.1 (−1.5 to –0.7) | <.001 |
| Primary care physician | 56 (53-58) | 53 (51-55) | −3 (−5 to 0) | .05 | −0.6 (−0.8 to –0.4) | <.001 |
| Specialty physician | 75 (71-78) | 73 (69-77) | −2 (−7 to 3) | .45 | −0.5 (−0.9 to –0.2) | .002 |
| Emergency department | 15 (14-16) | 14 (13-15) | −1 (−2 to 0) | .17 | 0 (−0.1 to 0) | .28 |
| Inpatient hospitalization | 6 (5-6) | 5 (4-5) | −1 (−2 to –1) | <.001 | −0.1 (−0.1 to –0.1) | <.001 |
| Dental | 48 (46-50) | 49 (47-51) | 1 (−2 to 3) | .59 | −0.8 (−1.0 to –0.6) | <.001 |
| Home health visit | 2 (2-3) | 3 (2-4) | 1 (0-2) | .12 | 0.1 (0.1-0.2) | .02 |
| Age >40 & <65 Years | ||||||
| Physician | 203 (198-208) | 208 (203-213) | 5 (−1 to 12) | .08 | −1.4 (−1.9 to –0.9) | <.001 |
| Primary care physician | 104 (101-107) | 107 (103-110) | 3 (−1 to 7) | .13 | −1.3 (−1.6 to –1.0) | <.001 |
| Specialty physician | 119 (115-123) | 122 (118-126) | 3 (−3 to 8) | .34 | −0.4 (−0.8 to 0) | .03 |
| Emergency department | 15 (14-16) | 16 (15-17) | 1 (−1 to 2) | .23 | 0.1 (0.1-0.2) | .001 |
| Inpatient hospitalization | 7 (7-8) | 7 (6-7) | −1 (−1 to 0) | .11 | −0.1 (−0.1 to 0) | .005 |
| Dental | 70 (67-73) | 71 (68-74) | 1 (−2 to 5) | .48 | −1.3 (−1.6 to –1.1) | <.001 |
| Home health visit | 8 (6-9) | 10 (8-12) | 2 (0-4) | .07 | 0.2 (0-0.3) | .04 |
| Age ≥65 Years | ||||||
| Physician | 364 (352-376) | 370 (359-381) | 5 (−10 to 20) | .49 | −1.4 (−2.4 to –0.4) | .005 |
| Primary care physician | 185 (178-191) | 183 (176-190) | −2 (−10 to 7) | .72 | −3.0 (−3.7 to –2.4) | <.001 |
| Specialty physician | 235 (224-247) | 245 (235-255) | 10 (−4 to 24) | .16 | 1.4 (0.5-2.3) | .003 |
| Emergency department | 21 (20-23) | 26 (24-28) | 5 (3-7) | <.001 | 0.1 (0-0.3) | .1 |
| Inpatient hospitalization | 16 (14-17) | 18 (16-20) | 2 (0-4) | .04 | −0.3 (−0.4 to –0.2) | <.001 |
| Dental | 83 (78-88) | 89 (84-94) | 6 (0-11) | .04 | 0.5 (0-1.0) | .05 |
| Home health visit | 44 (38-50) | 50 (44-56) | 6 (0-13) | .07 | 0.1 (−0.5 to 0.7) | .78 |
| Poverty Category | Pre (2012-2013) | Post (2014-2015) | Difference | P Value | Rate of Change (per Year, 2002-2016) | P Value |
|---|---|---|---|---|---|---|
| ≤200% Poverty Line | ||||||
| Physician | 176 (171-181) | 179 (174-184) | 3 (−3 to 9) | .32 | −0.9 (−1.4 to –0.4) | <.001 |
| Primary care physician | 103 (99-106) | 103 (100-107) | 1 (−3 to 5) | .73 | −0.9 (−1.3 to –0.6) | <.001 |
| Specialty physician | 90 (86-94) | 92 (88-96) | 2 (−3 to 6) | .52 | 0 (−0.8 to –0.2) | .93 |
| Emergency department | 22 (21-23) | 23 (22-25) | 1 (0-3) | .06 | 0.1 (0-0.2) | .17 |
| Inpatient hospitalization | 9 (9-10) | 9 (9-10) | 0 (−1 to 1) | .89 | −0.1 (−0.2 to –0.1) | <.001 |
| Dental | 44 (42-46) | 45 (43-48) | 2 (−1 to 4) | .22 | 0.1 (−0.1 to 0.4) | .22 |
| Home health visit | 19 (16-22) | 24 (22-27) | 5 (2-8) | .001 | 0.4 (0.2-0.6) | .001 |
| >200% & ≤400% Poverty Line | ||||||
| Physician | 176 (170-182) | 176 (171-181) | 0 (−7 to 7) | .97 | −1.7 (−2.2 to –1.3) | <.001 |
| Primary care physician | 97 (93-100) | 98 (95-102) | 2 (−3 to 6) | .49 | −1.4 (−1.7 to –1.2) | <.001 |
| Specialty physician | 95 (90-100) | 94 (90-98) | −1 (−7 to 5) | .81 | −0.5 (−0.8 to –0.2) | .002 |
| Emergency department | 14 (13-15) | 14 (13-15) | 0 (−1 to 2) | .63 | 0 (−0.1 to 0.1) | .96 |
| Inpatient hospitalization | 7 (7-8) | 6 (5-7) | −1 (−2 to 0) | .03 | −0.1 (−0.1 to 0) | .001 |
| Dental | 64 (61-67) | 64 (61-67) | 0 (−4 to 4) | .88 | −0.8 (−1.1 to –0.5) | <.001 |
| Home health visit | 8 (7-10) | 9 (7-10) | 1 (−1 to 2) | .53 | 0 (−0.1 to 0.1) | .65 |
| >400% Poverty Line | ||||||
| Physician | 207 (201-214) | 210 (203-215) | 2 (−6 to 10) | .60 | −1.1 (−1.5 to –0.6) | <.001 |
| Primary care physician | 105 (102-109) | 106 (102-109) | 1 (−3 to 5) | .68 | −1.3 (−1.6 to –1.0) | <.001 |
| Specialty physician | 123 (117-128) | 125 (120-130) | 3 (−4 to 9) | .45 | 0.1 (−0.3 to 0.4) | .75 |
| Emergency department | 10 (10-11) | 12 (11-12) | 1 (0-2) | .02 | 0 (−0.1 to 0) | .21 |
| Inpatient hospitalization | 6 (5-6) | 5 (5-6) | 0 (−1 to 1) | .86 | −0.1 (−0.1 to –0.1) | <.001 |
| Dental | 92 (89-96) | 95 (91-98) | 2 (−2 to –6) | .28 | −1.2 (−1.5 to –0.9) | <.001 |
| Home health visit | 5 (4-6) | 6 (5-7) | 1 (0-3) | .06 | −0.1 (−0.2 to 0) | .02 |
The pre- and post-Affordable Care Act numbers are numbers of individuals per 1,000 per month who reported contact with a type of care. The difference is the change in individuals per 1,000 per month between the pre- and post-ACA periods. The P value was obtained using adjusted Wald tests. The rate of change numbers represent the trends that were inclusive of the entire study period (2002-2016). The numbers represent the change in the number of individuals per 1,000 per month per year that had contact with a service. These trends were obtained using multivariable linear regression models that included, as appropriate, age, age2, and sex as covariates. The inclusion of age and age2 resulted in larger decreases (among nearly all categories) than when excluded in the models. Numbers in parentheses are 95% CIs.
Rate of change values for Overall Population and Poverty Category sections adjusted for age, age2, and sex.
Rate of change values for Age Category section adjusted for sex.