An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act
An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act
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DOI：
10.1370/afm.1741
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发表时间：
2015-01-01
影响因子：
4.4
通讯作者：
Devoe, Jennifer E.
中科院分区：
文献类型：
--
作者：
Angier, Heather;Hoopes, Megan;Devoe, Jennifer E.
2010年《平价医疗法案》支持美国医疗补助覆盖范围的显著扩大。截至2014年1月1日，共有25个州和哥伦比亚特区扩大了医疗补助计划。我们检验了一个假设，即与未实施医疗补助扩张的州相比，实施医疗补助扩张的州未投保的安全网诊所就诊率将显著下降。方法我们对社区卫生中心成人就诊的覆盖状况进行了纵向观察研究，从医疗补助扩张前12个月开始（2013年1月1日至2013年12月31日）至扩张后6个月（2014年1月1日至2014年6月30日）。我们分析了来自OCHIN基于实践的研究网络中的156家诊所的数据，这些诊所共享电子健康记录，位于9个州（5个扩大了医疗补助覆盖范围，4个没有）。结果分析基于333，655名非妊娠成年患者和他们的1，276，298次面对面计费遭遇。总体而言，扩张州的诊所在扩张后时期的无保险就诊率下降了40%，医疗补助覆盖的就诊率增加了36%。相比之下，诊所在非扩张状态有一个显着的16%的下降率无保险的访问，但没有变化的医疗补助覆盖visits.Conclusions率有一个显着的下降，在无保险的社区卫生中心访问和医疗补助覆盖的访问显着增加，在研究诊所的国家，扩大医疗补助在2014年，而选择退出扩大的州的研究诊所的无保险就诊率仍然很高。这些研究结果表明，与平价医疗法案相关的医疗补助扩张成功地减少了美国未投保的安全网患者的数量。
PURPOSE The Affordable Care Act of 2010 supports marked expansions in Medicaid coverage in the United States. As of January 1, 2014, a total of 25 states and the District of Columbia expanded their Medicaid programs. We tested the hypothesis that rates of uninsured safety net clinic visits would significantly decrease in states that implemented Medicaid expansion, compared with states that did not.METHODS We undertook a longitudinal observational study of coverage status for adult visits in community health centers, from 12 months before Medicaid expansion (January 1, 2013 to December 31, 2013) through 6 months after expansion (January 1, 2014 to June 30, 2014). We analyzed data from 156 clinics in the OCHIN practice-based research network, with a shared electronic health record, located in 9 states (5 expanded Medicaid coverage and 4 did not).RESULTS Analyses were based on 333,655 nonpregnant adult patients and their 1,276,298 in-person billed encounters. Overall, clinics in the expansion states had a 40% decrease in the rate of uninsured visits in the postexpansion period and a 36% increase in the rate of Medicaid-covered visits. In contrast, clinics in the nonexpansion states had a significant 16% decline in the rate of uninsured visits but no change in the rate of Medicaid-covered visits.CONCLUSIONS There was a substantial decrease in uninsured community health center visits and a significant increase in Medicaid-covered visits in study clinics in states that expanded Medicaid in 2014, whereas study clinics in states opting out of the expansion continued to have a high rate of uninsured visits. These findings suggest that Affordable Care Act-related Medicaid expansions have successfully decreased the number of uninsured safety net patients in the United States.