Lessons For Coverage Expansion: A Virginia Primary Care Program For The Uninsured Reduced Utilization And Cut Costs
Lessons For Coverage Expansion: A Virginia Primary Care Program For The Uninsured Reduced Utilization And Cut Costs
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DOI：
10.1377/hlthaff.2011.0857
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发表时间：
2012-02-01
期刊：
影响因子：
9.7
通讯作者：
Retchin, Sheldon M.
中科院分区：
文献类型：
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作者：
Bradley, Cathy J.;Gandhi, Sabina Ohri;Retchin, Sheldon M.
《平价医疗法案》将扩大约 3200 万未参保美国人的医疗保险覆盖范围。增加获得护理的机会旨在减少不必要的服务使用，例如急诊科就诊，并实现大幅成本节省。然而，这种说法几乎没有证据支持。为了确定一旦获得保险覆盖，未参保的人可能会如何反应，我们研究了在弗吉尼亚联邦大学医学中心参加基于社区的初级保健计划的未参保的低收入成年人。对于持续参加该计划的人来说，研究期间急诊科就诊和住院人数下降，而初级保健就诊有所增加。该群体的住院费用逐年下降。在注册的三年中，每个注册者每年的平均总费用从 8,899 美元下降到 4,569 美元，节省了近 50%。我们的结论是，以前未投保的人在接受保险后可能会减少急诊就诊次数并降低费用，但可能需要几年的保险才能节省大量医疗费用。
The Affordable Care Act will expand health insurance coverage for an estimated thirty-two million uninsured Americans. Increased access to care is intended to reduce the unnecessary use of services such as emergency department visits and to achieve substantial cost savings. However, there is little evidence for such claims. To determine how the uninsured might respond once coverage becomes available, we studied uninsured low-income adults enrolled in a community-based primary care program at Virginia Commonwealth University Medical Center. For people continuously enrolled in the program, emergency department visits and inpatient admissions declined, while primary care visits increased during the study period. Inpatient costs fell each year for this group. Over three years of enrollment, average total costs per year per enrollee fell from $8,899 to $4,569-a savings of almost 50 percent. We conclude that previously uninsured people may have fewer emergency department visits and lower costs after receiving coverage but that it may take several years of coverage for substantive health care savings to occur.