Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012-2015.
Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012-2015.
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DOI：
10.1186/s12913-023-09696-x
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发表时间：
2023-07-03
影响因子：
2.8
通讯作者：
Mafi, John N.
中科院分区：
文献类型：
--
作者：
Parzuchowski, Aaron;Oronce, Carlos;Guo, Rong;Tseng, Chi-Hong;Fendrick, A. Mark;Mafi, John N.
虽然平价医疗法案的医疗补助扩大改善了数百万未参保美国人的医疗覆盖范围和获得机会，但人们对其对所有支付者的整体可获得性和医疗质量的影响知之甚少。新登记的医疗补助患者数量的快速增加可能会无意中造成可获得性或护理质量的紧张。我们评估了与医疗补助在所有支付者中扩大相关的医生办公室就诊和高价值和低价值护理的变化。在8个选择扩大医疗补助的州和5个没有选择扩大医疗补助的州进行了医疗补助扩大前后的预先指定的、准实验性的差异分析(2012-2015)。医生办公室来访的样本来自国家动态医疗保健调查，与美国人口普查人口估计值标准化。结果包括每个州人口的就诊率以及分别由10项高价值措施和7项低价值护理措施组成的高价值或低价值服务复合率，按年份和保险分层。在2012-2015年间，我们确定了大约1.43亿成年人使用了19亿次访问(平均年龄56岁；60%是女性)。与非扩张州相比，扩张州在扩张后每百名成年人的医疗补助就诊次数增加了16.2%(p = 0.031 95%CI 1.5-31.0)。每百名成年人新增3.1%的医疗补助(95%CI为0.9-5.3，p = 为0.007)。医疗保险或商业保险的就诊率没有变化。任何保险类型的高价值或低价值护理都没有变化，除了新的医疗补助期间的高价值护理，每百名成年人增加了4.3万项服务(95%CI 1.1-7.5p = 0.009)。在医疗补助计划扩大后，美国医疗保健系统增加了数百万医疗补助参保人获得护理和使用高价值服务的机会，而那些参加其他保险类型的人的参保机会或质量没有明显下降。低价值医疗服务的提供在扩大后继续以类似的比率提供，这为未来旨在提高医疗服务价值的联邦政策提供了信息。网上版载有补充材料，可在10.1186/s12913-023-09696-x查阅。
While the Affordable Care Act’s Medicaid expansion improved healthcare coverage and access for millions of uninsured Americans, less is known about its effects on the overall accessibility and quality of care across all payers. Rapid volume increases of newly enrolled Medicaid patients might have unintentionally strained accessibility or quality of care. We assessed changes in physician office visits and high- and low-value care associated with Medicaid expansion across all payers. Prespecified, quasi-experimental, difference-in-differences analysis pre and post Medicaid expansion (2012–2015) in 8 states that did and 5 that did not choose to expand Medicaid. Physician office visits sampled from the National Ambulatory Medical Care Survey, standardized with U.S. Census population estimates. Outcomes included visit rates per state population and rates of high or low-value service composites of 10 high-value measures and 7 low-value care measures respectively, stratified by year and insurance. We identified approximately 143 million adults utilizing 1.9 billion visits (mean age 56; 60% female) during 2012–2015. Medicaid visits increased in expansion states post-expansion compared to non-expansion states by 16.2 per 100 adults (p = 0.031 95% CI 1.5–31.0). New Medicaid visits increased by 3.1 per 100 adults (95% CI 0.9–5.3, p = 0.007). No changes were observed in Medicare or commercially-insured visit rates. High or low-value care did not change for any insurance type, except high-value care during new Medicaid visits, which increased by 4.3 services per 100 adults (95% CI 1.1–7.5, p = 0.009). Following Medicaid expansion, the U.S. healthcare system increased access to care and use of high-value services for millions of Medicaid enrollees, without observable reductions in access or quality for those enrolled in other insurance types. Provision of low-value care continued at similar rates post-expansion, informing future federal policies designed to improve the value of care. The online version contains supplementary material available at 10.1186/s12913-023-09696-x.
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影响因子：
--
作者：
Ma, J;Stafford, RS
通讯作者：
Stafford, RS
影响因子：
9.7
作者：
Cole, Megan B.;Galarraga, Omar;Trivedi, Amal N.
通讯作者：
Trivedi, Amal N.
影响因子：
3.5
作者：
Gruber, Jonathan;Simon, Kosali
通讯作者：
Simon, Kosali
影响因子：
6.2
作者：
Carey, Colleen M.;Miller, Sarah;Wherry, Laura R.
通讯作者：
Wherry, Laura R.
影响因子：
39
作者：
Kale, Minal S.;Bishop, Tara F.;Keyhani, Salomeh
通讯作者：
Keyhani, Salomeh