The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists.
The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists.
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DOI：
10.1097/mlr.0000000000001703
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发表时间：
2022-05-01
期刊：
影响因子：
3
通讯作者：
Yu H
中科院分区：
文献类型：
--
作者：
Escarce JJ;Wozniak GD;Tsipas S;Pane JD;Ma Y;Brotherton SE;Yu H
最近的一项研究发现，根据《平价医疗法案》（ACA）扩大医疗补助的州获得了新的普通内科医生，他们正在建立自己的第一个实践，而非扩张州则失去了他们。本研究的目的是检查社会不利的水平的扩张状态，获得新的医生和非扩张状态的地区，失去了他们。我们使用美国社区调查数据将通勤区分为高，中，低社会劣势。使用来自AMA医师主文件的2009-2019年数据和各州医疗补助扩展状态的信息，我们估计了条件logit模型，以比较扩展后6年内新医生的位置与扩展前5年内的位置。新增普通内科医生32，102名。与扩张前的模式相比，新的普通内科医生更有可能在扩张后处于扩张状态，这一发现适用于高、中、低劣势区域。我们估计，在2014年至2019年期间，非扩张状态失去了371名新的普通内科医生（95%置信区间，203-540）。然而，62.5%的医生失去了nonexpansion状态失去了高度不利的地区，即使这些地区只占17.9%的人口nonexpansion状态。选择不扩大医疗补助的州将新的普通内科医生输给了扩大的州。非扩张州失去的医生中，极不成比例的一部分来自高度弱势地区，这可能会影响所有居民的医疗服务，无论他们是否有保险。
A recent study found that states that expanded Medicaid under the Affordable Care Act (ACA) gained new general internists who were establishing their first practices, whereas nonexpansion states lost them. The objective of this study was to examine the level of social disadvantage of the areas of expansion states that gained new physicians and the areas of nonexpansion states that lost them. We used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. Using 2009–2019 data from the AMA Physician Masterfile and information on states’ Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following the expansion to where they located during the 5 years preceding the expansion. A total of 32,102 new general internists. Compared with preexpansion patterns, new general internists were more likely to locate in expansion states after the expansion, a finding that held for high, medium, and low disadvantage areas. We estimated that, between 2014 and 2019, nonexpansion states lost 371 new general internists (95% confidence interval, 203–540) to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas even though these areas only accounted for 17.9% of the population of nonexpansion states. States that opted not to expand Medicaid lost new general internists to expansion states. A highly disproportionate share of the physicians lost by nonexpansion states were lost from high disadvantage areas, potentially compromising access for all residents irrespective of insurance coverage.