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Objectives. To evaluate how met need for accessibility and availability of primary care among nonelderly individuals in Georgia will be affected by the Patient Protection and Affordable Care Act (ACA) over the next 10 years.
Methods. We used a stock-and-flow model to predict the number of available visits from 2013 to 2025, regression models to project needed visits, and an optimization model to estimatemet need.The outputs of thesemodelswere used to estimate unmet need and the availability and accessibility of primary care.
Results. Our findings showed that the number of primary care providers will increase by 9.2% to 11.7% by 2025 and that the number of needed visits will increase by 20%. Under Medicaid expansion, the percentage of met need will increase from 67% to 80%. Accessibility will improve by 20% under expansion, and availability will decrease by 13% to 19% under expansion.
Conclusions. The ACAs' provisions will reduce unmet need and positively affect accessibility while reducing availability in some communities. Increased need because of a larger Medicaid population under Medicaid expansion will not be a significant burden on the privately insured population. (Am J Public Health. 2016;106:1470-1476. doi: 10.2105/AJPH.2016.303222)
Health care access has been on the US national policy agenda since the 1967 report of the National Advisory Commission on Health Manpower.1 Several policy interventions have been implemented and evaluated to improve health care access,2 most recently the provisions outlined in the Patient Protection and Affordable Care Act (ACA; Pub L No. 111-148). One primary emphasis of the ACA is to eliminate disparities in financial access to health care.
Although affordability (i.e., financial access) is an essential dimension of health care access, other dimensions such as availability and accessibility are equally relevant in eliminating health disparities. Availability refers to the opportunity patients have to choose among health care providers,3 whereas accessibility refers to the time or distance barriers faced by patients in reaching their providers. Spatial access, referring to availability and accessibility in combination,3 is critical in promoting preventive care and reducing severe health outcomes. Lack of spatial access to health care can lead to higher costs, more frequent emergency outbreaks, and inconsistency in health outcomes.
Because the ACA's implementation will transform health care delivery in ways that are not fully understood, it is...