Changes in Emergency Department Utilization After Early Medicaid Expansion in California
Changes in Emergency Department Utilization After Early Medicaid Expansion in California
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DOI：
10.1097/mlr.0000000000000699
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发表时间：
2017-06-01
期刊：
影响因子：
3
通讯作者：
Tehrani, Ali Bonakdar
中科院分区：
文献类型：
--
作者：
Sabik, Lindsay M.;Cunningham, Peter J.;Tehrani, Ali Bonakdar
背景：医疗补助的扩展旨在改善初级保健的可及性，这可能会减少急诊科（艾德）的非紧急（NE）使用。相比之下，医疗补助注册者使用艾德比其他群体，包括没有保险。因此，医疗补助扩张对艾德使用的预期影响尚不清楚。Objectives：估计加州根据《平价医疗法案》（Affordable Care Act）的早期医疗补助扩张导致的总就诊量和NE艾德就诊量的变化。除了访问的数量的总体变化，付款人和安全网医院状态的变化examined.Methods：我们使用了一个准实验的方法来检查艾德利用率的变化，比较加州扩展县，比较县从加州州和其他2个州在同一地区，在研究期间没有实施医疗补助扩展。结果：回归估计显示没有显着变化的总人数艾德访问扩展后。医疗补助扩张后的第一年，每个医院季度的就诊次数增加了145次，第一年之后增加了242次，而无保险患者的就诊次数在第一年每个医院季度减少了129次，在随后的几年中减少了175次，受安全网医院变化的推动。我们还观察到，由医疗补助支付的医院季度NE访问的增加，并在无保险的NE visits.Conclusions显着减少：医疗补助在加州的扩张与医疗补助支付的艾德访问的增加和无保险访问的下降。扩大也与医疗补助登记者和无保险者的NE访问变化有关。
Background:Medicaid expansions aim to improve access to primary care, which could reduce nonemergent (NE) use of the emergency department (ED). In contrast, Medicaid enrollees use the ED more than other groups, including the uninsured. Thus, the expected impact of Medicaid expansion on ED use is unclear.Objectives:To estimate changes in total and NE ED visits as a result of California's early Medicaid expansion under the Affordable Care Act. In addition to overall changes in the number of visits, changes by payer and safety net hospital status are examined.Methods:We used a quasi-experimental approach to examine changes in ED utilization, comparing California expansion counties to comparison counties from California and 2 other states in the same region that did not implement Medicaid expansion during the study period.Results:Regression estimates show no significant change in total number of ED visits following expansion. Medicaid visits increased by 145 visits per hospital-quarter in the first year following expansion and 242 visits subsequent to the first year, whereas visits among uninsured patients decreased by 129 visits per hospital-quarter in the first year and 175 visits in subsequent years, driven by changes at safety net hospitals. We also observe an increase in NE visits per hospital-quarter paid for by Medicaid, and a significant decrease in uninsured NE visits.Conclusions:Medicaid expansions in California were associated with increases in ED visits paid for by Medicaid and declines in uninsured visits. Expansion was also associated with changes in NE visits among Medicaid enrollees and the uninsured.