Impact of Subsidized Health Insurance Coverage on Emergency Department Utilization by Low-income Adults in Massachusetts.
Impact of Subsidized Health Insurance Coverage on Emergency Department Utilization by Low-income Adults in Massachusetts.
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补贴健康保险覆盖范围对马萨诸塞州低收入成年人使用急诊室的影响。
DOI：
10.1097/mlr.0000000000000279
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发表时间：
2015
期刊：
影响因子：
3
通讯作者：
McCarthy,MelissaL
中科院分区：
文献类型：
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作者：
Lee,Jennifer;Ding,Ru;Zeger,ScottL;McDermott,Aidan;Habteh-Yimer,Getachew;Chin,Michael;Balder,RebeccaS;McCarthy,MelissaL
背景：2006年，马萨诸塞州将保险覆盖范围扩大到许多低收入人群。目的：本研究旨在估计马萨诸塞州医疗改革后符合补贴医疗保险资格的队列中每个个体的急诊科（ED）利用率的变化。研究设计：我们获得了2004-2008财政年度马萨诸塞州公共医疗保险登记数据，并确定了353515名参加联邦医疗保险的成年人，这是一项为低收入成年人提供保险补贴的计划。我们将登记数据与全州范围内的急诊科就诊索赔合并，并创建了一个纵向文件，该文件显示了每个登记者在登记前和登记后每个月的急诊科就诊情况和保险状况。测量方法：我们通过条件逻辑回归估计了个体在治疗后与治疗前就诊的几率之比。结果：在112,146名在研究期间至少进行过1次急诊科就诊的CommCare参与者中，个体急诊科就诊的几率下降了4%[优势比(OR)= 0.96；95%可信区间（CI）， 0.94, 0.98]。然而，根据登记前的保险状况，它的差异很大。在之前没有公共保险的参保者中，一个人的急诊科就诊几率在后期间高出12% (OR= 1.12; 95% CI, 1.10, 1.25)，但在从健康安全网（一项为低收入个人支付有限服务的计划）过渡过来的参保者中，这一几率低18% （OR= 0.82; 95% CI, 0.78, 0.85）。结论：扩大补贴医疗保险并没有统一地改变马萨诸塞州所有新投保的低收入成年人对ED的利用。
Background:In 2006, Massachusetts expanded insurance coverage to many low-income individuals.Objectives:This study aimed to estimate the change in emergency department (ED) utilization per individual among a cohort who qualified for subsidized health insurance following the Massachusetts health care reform.Research Design:We obtained Massachusetts public health insurance enrollment data for the fiscal years 2004–2008 and identified 353,515 adults who enrolled in Commonwealth Care, a program that subsidizes insurance for low-income adults. We merged the enrollment data with statewide ED visit claims and created a longitudinal file that indicated each enrollee’s ED visits and insurance status each month during the preenrollment and postenrollment periods.Measures:We estimated the ratio in an individual’s odds of an ED visit during the postperiod versus preperiod by conditional logistic regression.Results:Among the 112,146 CommCare enrollees who made at least 1 ED visit during the study period, an individual’s odds of an ED visit decreased 4%[odds ratio (OR)= 0.96; 95% confidence interval (CI), 0.94, 0.98] postenrollment. However, it varied significantly depending on preenrollment insurance status. A person’s odds of an ED visit was 12% higher in the postperiod among enrollees not publicly insured prior (OR= 1.12; 95% CI, 1.10, 1.25), but was 18% lower among enrollees who transitioned from the Health Safety Net, a program that pays for limited services for low-income individuals (OR= 0.82; 95% CI, 0.78, 0.85).Conclusions:Expanding subsidized health insurance did not uniformly change ED utilization for all newly insured low-income adults in Massachusetts.