Impacts of early ACA Medicaid expansions on physician participation.
Impacts of early ACA Medicaid expansions on physician participation.
复制标题
早期 ACA 医疗补助扩展对医生参与的影响。
DOI：
10.1111/1475-6773.13925
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发表时间：
2022
影响因子：
3.4
通讯作者：
Bhole,Monica
中科院分区：
文献类型：
--
作者：
Curto,Vilsa;Bhole,Monica
目的量化早期平价医疗法案（ACA）医疗补助扩大对初级保健医生参与医疗补助的影响。数据来源该研究使用了2009-2012年美国医疗补助分析提取（MAX）的二级数据，以及2015年美国国家计划和提供者枚举系统（NPPES）的二级数据。研究设计本研究采用准实验异中异研究设计，其中政策变化是在2010年和2011年采用ACA早期医疗补助扩张的六个州的医疗补助扩张：加利福尼亚州，康涅狄格州，哥伦比亚特区，明尼苏达州，新泽西州和华盛顿州。关键的结果变量是医生参与的五个月测量指标：医疗补助就诊次数，医疗补助患者数量，至少看1名医疗补助患者，至少看25名医疗补助患者，至少看50名医疗补助患者。数据收集/提取方法根据NPPES，样本包括2005年至2015年期间活跃的所有医生。主要发现：对于初级保健医生，医疗补助扩大导致医疗补助就诊增加29%（每月5.88次；95% CI: 2.49-9.27），医疗补助患者增加29%（每月4.59次；95% CI: 2.16-7.02），并且不影响任何医疗补助参与的可能性。医疗补助扩张还导致每月至少收治25名医疗补助患者的概率增加22%(4.58个百分点；95% CI: 1.27-7.89)，每月至少收治50名医疗补助患者的概率增加31%（2.99个百分点；95% CI: 0.99-4.99）。结论早期ACA医疗补助计划的扩大导致初级保健医生的医疗补助就诊增加，但不影响任何医疗补助计划参与的可能性。以前为医疗补助病人服务的初级保健医生通过为更多的医疗补助病人服务来回应早期ACA医疗补助计划的扩张。
ObjectiveTo quantify impacts of early Affordable Care Act (ACA) Medicaid expansions on Medicaid participation for primary care physicians.Data SourcesThe study uses secondary Medicaid Analytic eXtract (MAX) data from the United States for 2009–2012, as well as secondary National Plan and Provider Enumeration System (NPPES) data from the United States for 2015.Study DesignThe study uses a quasi‐experimental difference‐in‐differences study design where the policy change is Medicaid expansion in six states that adopted early ACA Medicaid expansions during 2010 and 2011: California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington. The key outcome variables are five monthly measures of physician participation: the number of Medicaid visits, the number of Medicaid patients, seeing at least 1 Medicaid patient, seeing at least 25 Medicaid patients, and seeing at least 50 Medicaid patients.Data Collection/Extraction MethodsThe sample consists of all physicians who were active between 2005 and 2015, according to the NPPES.Principal FindingsFor primary care physicians, Medicaid expansion led to a 29% increase in Medicaid visits (5.88 per month; 95% CI: 2.49–9.27), a 29% increase in Medicaid patients (4.59 per month; 95% CI: 2.16–7.02), and did not affect the probability of any Medicaid participation. Medicaid expansion also led to a 22% increase in the probability of seeing at least 25 Medicaid patients per month (4.58 percentage points; 95% CI: 1.27–7.89) and a 31% increase in the probability of seeing at least 50 Medicaid patients per month (2.99 percentage points; 95% CI: 0.99–4.99).ConclusionsEarly ACA Medicaid expansions led to increased Medicaid visits for primary care physicians but did not affect the probability of any Medicaid participation. Primary care physicians who had previously served Medicaid patients responded to early ACA Medicaid expansions by serving substantially more Medicaid patients.