摘要：Objectives. We sought to describe changes in young adults’ routine care and usual sources of care (USCs), according to provider specialty, after implementation of extended dependent coverage under the Affordable Care Act (ACA) in 2010. Methods. We used Medical Expenditure Panel Survey data from 2006 to 2012 to examine young adults’ receipt of routine care in the preceding year, identification of a USC, and USC provider specialties (pediatrics, family medicine, internal medicine, and obstetrics and gynecology). Results. The percentage of young adults who sought routine care increased from 42.4% in 2006 to 49.5% in 2012 ( P < .001). The percentage identifying a USC remained stable at approximately 60%. Among young adults with a USC, there was a trend between 2006 and 2012 toward increasing percentages with pediatric (7.6% vs 9.1%) and family medicine (75.9% vs 80.9%) providers and declining percentages with internal medicine (11.5% vs 7.6%) and obstetrics and gynecology (5.0% vs 2.5%) providers. Conclusions. Efforts under the ACA to increase health insurance coverage had favorable effects on young adults’ use of routine care. Monitoring routine care use and USC choices in this group can inform primary care workforce needs and graduate medical education priorities across specialties. Decreasing the number of uninsured Americans is a central goal of the Affordable Care Act (ACA; Pub L No. 111-148). Historically, young adults have been less likely than adolescents and older adults to have insurance coverage. 1–3 In addition to low coverage rates, previous research suggests that emergency department use is higher among young adults than adolescents and that use of primary care services is lower. 2,4,5 This decreased access to and use of health care occurs during a period of risky behavior that results in high preventable mortality and morbidity rates among young adults. 6–8 The ACA offers several mechanisms for increasing health insurance coverage among young adults. One of the earliest expansions under the ACA occurred on September 23, 2010, when all insurance plans offering dependent coverage were required to extend this coverage to young adults until they were 26 years old. 1 The requirement does not depend on an individual’s living situation or student, marriage, or tax-dependent status. Previously, most employer-based health insurance plans terminated young people’s dependent coverage at the age of 19 years or upon their graduation from college. 9 The extended dependent coverage provision has resulted in more than 3 million young adults gaining health insurance coverage. 10 One anticipated impact of expanded insurance coverage for young adults was increased access to primary care services. 11–15 Studies involving data from 2011, immediately after implementation of extended dependent coverage, demonstrated increases in young adults’ receipt of routine and preventive care 16 and declines in the numbers of young adults forgoing care and experiencing delays in care as a result of high costs. 12 However, other researchers found no significant changes in young adults’ use of routine health care services in 2011 and 2012, and no significant increases in the proportion of young adults with a usual source of care (USC). 12,15,17 Recent health insurance marketplaces and 2013 state-based Medicaid expansions have further increased rates of insurance coverage among young adults and are expected to subsequently affect their use of health care. 18–20 Because young adults may see providers from multiple specialties, including pediatrics, family medicine, internal medicine, and obstetrics and gynecology, monitoring not only whether their use of routine care changes but also what types of providers they identify as their USC can inform efforts to determine how to best meet this population’s health care needs. In this study, we sought to add to the existing literature by using nationally representative data from 2006 to 2012 to describe changes in young adults’ use of routine care and their USC choices.
