Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-affordable Care Act Medicaid Expansion?
Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-affordable Care Act Medicaid Expansion?
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DOI：
10.1097/mlr.0000000000001189
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发表时间：
2019-10-01
期刊：
影响因子：
3
通讯作者：
DeVoe, Jennifer
中科院分区：
文献类型：
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作者：
Holderness, Heather;Angier, Heather;DeVoe, Jennifer
背景：之前的研究表明，新的医疗补助投保人更有可能使用急诊科 (ED)，但他们没有区分已建立或未建立初级保健的患者。目标：了解患者保护和平价医疗法案 (PPACA) 医疗补助扩展（急诊科、初级保健或专科）后俄勒冈州医疗补助受益人在哪里寻求护理，以及初级保健机构和门诊护理利用之间的相互作用。研究设计：回顾性队列研究。受试者：从 2014 年到 2015 年连续投保的成年人，无论是新投保的、返回的还是在 PPACA 后继续投保的。措施：首次和最后一次门诊就诊的地点，根据初级保健状况和门诊护理利用情况确定。结果：新患者首次就诊时获得初级保健的几率较低[比值比 (OR)，0.18；比值比 (OR)，0.18； 95% 置信区间 (CI), 0.18-0.19] 和再次投保 (OR, 0.22; 95% CI, 0.22-0.23) 比持续投保的情况要好。持续投保的初级保健新患者首次就诊时就诊急诊的几率高于新投保或返回的投保患者（OR，2.15；95% CI，2.01-2.30）。在所有保险组中，由单一初级保健提供者建立的患者的急诊就诊率较低，而与多个初级保健提供者建立的患者的急诊就诊率最高。结论：大多数新参保和返回的医疗补助参保者寻求初级保健而不是急诊服务，并且大多数人都接受了初级保健。我们的研究结果表明，保险和初级保健连续性在患者寻求医疗保健服务方面发挥着重要作用。
Background: Previous studies suggest the newly Medicaid insured are more likely to use the emergency department (ED) however they did not differentiate between patients established or not established with primary care. Objectives: To understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion (ED, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization. Research design: A retrospective cohort study. Subjects: Adults continuously insured from 2014 through 2015 who were either newly, returning, or continuously insured post-PPACA. Measures: Site of first and last outpatient visit, established with primary care status, and outpatient care utilization. Results: The odds of being established with primary care at their first visit were lower among newly [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.18-0.19] and returning insured (OR, 0.22; 95% CI, 0.22-0.23) than the continuously insured. Continuously insured, new patients with primary care had higher odds of visiting the ED (OR, 2.15; 95% CI, 2.01-2.30) at their first visit than newly or returning insured. Patients established with a single primary care provider in all insurance groups had lower rates of ED visit, whereas those established with multiple primary care providers had the highest ED visit rates. Conclusions: Most newly and returning insured Medicaid enrollees sought primary care rather than ED services and most became established with primary care. Our findings suggest that both insurance and primary care continuity play a role in where patients seek health care services.