Insurance Expansion In Massachusetts Did Not Reduce Access Among Previously Insured Medicare Patients
Insurance Expansion In Massachusetts Did Not Reduce Access Among Previously Insured Medicare Patients
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DOI：
10.1377/hlthaff.2012.1018
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发表时间：
2013-03-01
期刊：
影响因子：
9.7
通讯作者：
Jha, Ashish K.
中科院分区：
文献类型：
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作者：
Joynt, Karen E.;Chan, David;Jha, Ashish K.
马萨诸塞州的医疗改革是《平价医疗法案》的典范。批评者认为，保险扩张可能会产生负面溢出效应，导致已经投保的患者（如脆弱的医疗保险患者）的结果更糟。利用2004年至2009年的医疗保险数据，我们研究了马萨诸塞州与对照州相比，可预防性住院治疗的趋势，如不受控制的高血压和糖尿病，这是获得有效初级保健的标志。我们发现，在马萨诸塞州的医疗改革后，医疗保险患者的可预防住院率在马萨诸塞州实际上比对照州下降得更多（每10万名患者每季度减少101例入院，而每季度减少83例入院）。因此，我们没有发现任何证据表明马萨诸塞州的保险扩张对以前投保的可预防住院有有害的溢出效应。我们的研究结果应该提供一些保证，有可能扩大对未投保的美国人的访问，而不会对那些已经投保的人的重要临床结果产生负面影响。
Critics of Massachusetts's health reform, a model for the Affordable Care Act, have argued that insurance expansion probably had a negative spillover effect leading to worse outcomes among already insured patients, such as vulnerable Medicare patients. Using Medicare data from 2004 to 2009, we examined trends in preventable hospitalizations for conditions such as uncontrolled hypertension and diabetes-markers of access to effective primary care-in Massachusetts compared to control states. We found that after Massachusetts's health reform, preventable hospitalization rates for Medicare patients actually decreased more in Massachusetts than in control states (a reduction of 101 admissions per 100,000 patients per quarter compared to a reduction of 83 admissions). Therefore, we found no evidence that Massachusetts's insurance expansion had a deleterious spillover effect on preventable hospitalizations among the previously insured. Our findings should offer some reassurance that it is possible to expand access to uninsured Americans without negatively affecting important clinical outcomes for those who are already insured.