Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach.
Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach.
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DOI：
10.1186/s12961-021-00730-0
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发表时间：
2021-05-06
影响因子：
4
通讯作者：
Simpson KN
中科院分区：
文献类型：
--
作者：
Brown EA;White BM;Jones WJ;Gebregziabher M;Simpson KN
2010年的《患者保护和平价医疗法案》，通常被称为平价医疗法案（ACA），旨在增加获得初级医疗的机会，提高医疗质量，降低医疗成本。当各州被赋予自愿扩大医疗补助计划的选择权时，法律中强制扩大州医疗补助计划的关键条款发生了变化。我们的研究试图衡量ACA医疗补助扩大对可预防住院率（PH）的影响，PH是获得初级保健的一种衡量标准。我们对2012年至2015年八个州的季度住院率进行了中断时间序列分析。采用分段回归分析确定政策改革对PH值的影响。《平价医疗法案》的医疗补助扩张导致PH率下降（改善了获得医疗服务的机会）；然而，这一发现并不显著（系数估计：- 0.0059,CI - 0.0225, 0.0107, p = 0.4856）。医疗保健系统的特征，如每位参保者的医疗补助支出和医疗补助收入资格，与PH率（改善获得医疗服务的机会）的显着下降有关。然而，医疗补助到医疗保险费用指数（医生报销）和民主党州立法机构的PH率（难以获得医疗服务）显著增加。卫生政策改革和保健服务的特点影响到获得保健的机会。研究人员应该在更长的时间内继续评估更多州的这种政策变化。研究人员应该将这些发现转化为成本分析，以便国家决策者为其选民做出更明智的决策。对门诊护理敏感的条件是评估政策和衡量获得初级保健的可行方法。政策本身无法改善获得医疗服务的机会。必须处理其他因素（信任、沟通、决策者的动机和目标等）以改善获取。在线版本包含补充材料，可在10.1186/s12961-021-00730-0获得。
The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care. We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to 2015. Segmented regression analysis was utilized to determine the impact of policy reform on PH rates. The Affordable Care Act’s Medicaid expansion led to decreased rates of PH (improved access to care); however, the finding was not significant (coefficient estimate: −0.0059, CI −0.0225, 0.0107, p = 0.4856). Healthcare system characteristics, such as Medicaid spending per enrollee and Medicaid income eligibility, were associated with a significant decrease in rates of PH (improved access to care). However, the Medicaid-to-Medicare fee index (physician reimbursement) and states with a Democratic state legislature had a significant increase in rates of PH (poor access to care). Health policy reform and healthcare delivery characteristics impact access to care. Researchers should continue evaluating such policy changes across more states over longer periods of time. Researchers should translate these findings into cost analysis for state policy-makers to make better-informed decisions for their constituents. Ambulatory care-sensitive conditions are a feasible method for evaluating policy and measuring access to primary care. Policy alone cannot improve access to care. Other factors (trust, communication, policy-makers’ motivations and objectives, etc.) must be addressed to improve access. The online version contains supplementary material available at 10.1186/s12961-021-00730-0.
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影响因子：
4.8
作者：
Ricketts, TC;Randolph, R;Carey, T
通讯作者：
Carey, T
影响因子：
6.2
作者：
Smulowitz, Peter B.;Lipton, Robert;Landon, Bruce E.
通讯作者：
Landon, Bruce E.
影响因子：
3
作者：
Saha, Somnath;Solotaroff, Rachel;Bindman, Andrew B.
通讯作者：
Bindman, Andrew B.
影响因子：
9.7
作者：
BILLINGS, J;ZEITEL, L;NEWMAN, L
通讯作者：
NEWMAN, L
影响因子：
9.7
作者：
Golberstein, Ezra;Gonzales, Gilbert;Sommers, Benjamin D.
通讯作者：
Sommers, Benjamin D.