Medicaid increases emergency-department use: evidence from Oregon's Health Insurance Experiment.
Medicaid increases emergency-department use: evidence from Oregon's Health Insurance Experiment.
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DOI：
10.1126/science.1246183
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发表时间：
2014-01-17
期刊：
影响因子：
--
通讯作者：
Finkelstein AN
中科院分区：
文献类型：
--
作者：
Taubman SL;Allen HL;Wright BJ;Baicker K;Finkelstein AN
2008年，俄勒冈州启动了一项针对无保险、低收入成年人的医疗补助计划，通过抽签从等候名单中抽取名字。这种抽签创造了一个难得的机会，通过使用随机对照设计来研究医疗补助覆盖范围的影响。通过使用彩票和波特兰地区医院急诊室记录提供的随机化，我们研究了彩票后约18个月内约25，000名彩票参与者的急诊室使用情况。我们发现，医疗补助覆盖范围显着增加了整体紧急使用0.41访问每人，或40%，相对于平均1.02访问每人在对照组。我们发现，在各种类型的就诊、病情和亚组中，急诊科就诊的增加，包括在初级保健环境中最容易治疗的病情的就诊增加。
In 2008, Oregon initiated a limited expansion of a Medicaid program for uninsured, low-income adults, drawing names from a waiting list by lottery. This lottery created a rare opportunity to study the effects of Medicaid coverage by using a randomized controlled design. By using the randomization provided by the lottery and emergency-department records from Portland-area hospitals, we studied the emergency department use of about 25,000 lottery participants over about 18 months after the lottery. We found that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40% relative to an average of 1.02 visits per person in the control group. We found increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.
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