Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix
Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix
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DOI：
10.1377/hlthaff.2015.1632
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发表时间：
2016-08-01
期刊：
影响因子：
9.7
通讯作者：
Pilgrim, Randy
中科院分区：
文献类型：
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作者：
Pines, Jesse M.;Zocchi, Mark;Pilgrim, Randy
2014年，28个州和哥伦比亚特区扩大了医疗补助的资格，而每个州的联邦和州为基础的市场为合格的个人提供补贴的私人医疗保险。结果，大约1700万以前没有保险的美国人在2014年获得了医疗保险。许多政策制定者曾预测，医疗补助的扩大将导致医院急诊部门（ED）的使用大大增加。我们研究了保险扩张对36个州478家医院艾德使用的影响，在扩张的第一年（2014年）。在差异中差异分析中，与非扩展州相比，医疗补助扩展第一年期间，这些州由医疗补助支付的艾德就诊次数增加了27.1%，无保险就诊次数减少了31.4%，私人保险就诊次数减少了6.7%。然而，总体而言，与2012-13年相比，2014年的总艾德访问量增长不到3%，扩张和非扩张状态之间没有显著差异。因此，医疗补助覆盖范围的扩大强烈影响了支付者的组合，但并没有显着影响整体艾德的使用，即使更多的人获得保险覆盖范围的扩展国家比非扩展国家。这表明，扩大医疗补助并没有显着增加或减少整体艾德访问量。
In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014). In difference-in-differences analyses, Medicaid expansion increased Medicaid-paid ED visits in those states by 27.1 percent, decreased uninsured visits by 31.4 percent, and decreased privately insured visits by 6.7 percent during the first year of expansion compared to nonexpansion states. Overall, however, total ED visits grew by less than 3 percent in 2014 compared to 2012-13, with no significant difference between expansion and nonexpansion states. Thus, the expansion of Medicaid coverage strongly affected payer mix but did not significantly affect overall ED use, even though more people gained insurance coverage in expansion states than in nonexpansion states. This suggests that expanding Medicaid did not significantly increase or decrease overall ED visit volume.