At Federally Funded Health Centers, Medicaid Expansion Was Associated With Improved Quality Of Care
At Federally Funded Health Centers, Medicaid Expansion Was Associated With Improved Quality Of Care
复制标题
DOI：
10.1377/hlthaff.2016.0804
复制
发表时间：
2017-01-01
期刊：
影响因子：
9.7
通讯作者：
Trivedi, Amal N.
中科院分区：
文献类型：
--
作者：
Cole, Megan B.;Galarraga, Omar;Trivedi, Amal N.
2014年，在《平价医疗法案》扩大医疗补助资格的州，许多没有保险的低收入非老年人获得了医疗保险。联邦政府资助的社区卫生中心可能特别受到这种扩张的影响，因为他们的许多病人没有保险，收入也很低。我们使用了差异中的差异方法，比较了2011年至2014年在扩张州与非扩张州的1057个这样的中心在患者保险覆盖范围、服务的患者数量和提供的护理质量方面的变化。医疗补助扩张与医疗补助覆盖面的大幅增加（12个百分点）和相应的未保险率下降（11个百分点）有关。在扩展和非扩展状态下，服务的患者数量都有所增加，并且在不同状态组之间增加的幅度没有显着差异。医疗补助扩大与哮喘治疗、巴氏涂片检查、体重指数评估和高血压控制等8项指标中的4项质量改善有关。这一分析表明，各州关于扩大医疗补助的决定对医疗中心的患者有重要影响，扩大了慢性病的治疗和结果，并促进了推荐的预防服务的使用。
In 2014 many uninsured, low-income nonelderly adults gained access to health insurance in states that expanded Medicaid eligibility under the Affordable Care Act. Federally funded community health centers were likely to be particularly affected by this expansion because many of their patients were uninsured and low income. We used a difference-in-differences approach to compare changes among 1,057 such centers in expansion versus nonexpansion states from 2011 to 2014, in terms of their patients' insurance coverage, the number of patients they served, and the quality of care they provided. Medicaid expansion was associated with large increases (12 percentage points) in Medicaid coverage and corresponding declines (11 percentage points) in uninsurance rates. The numbers of patients served increased in both expansion and nonexpansion states, and the magnitude of increase did not differ significantly between the groups of states. Medicaid expansion was associated with improved quality on four of eight measures examined: asthma treatment, Pap testing, body mass index assessment, and hypertension control. This analysis suggests that states' decisions about Medicaid expansion have important consequences for health center patients, with expansion improving treatment and outcomes of chronic disease and bolstering the use of recommended preventive services.