Impact of ACA Medicaid Expansion on Hospitals' Financial Status
Impact of ACA Medicaid Expansion on Hospitals' Financial Status
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DOI：
10.1097/jhm-d-17-00177
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发表时间：
2019-03-01
影响因子：
1.8
通讯作者：
Rosenbaum, Sara
中科院分区：
文献类型：
--
作者：
Young, Gary J.;Flaherty, Stephen;Rosenbaum, Sara
患者保护和平价医疗法案的保险改革预计将对医院财务产生重大和积极的影响。特别是，州政府扩大医疗补助计划的承诺是，由于将医疗保险扩大到许多以前没有保险的个人，从而降低医院的未补偿护理成本。最近的研究表明，在医疗补助计划扩大的早期阶段，许多医院确实经历了无偿医疗费用的大幅下降。然而，到目前为止，研究还没有考虑到医疗补助计划的扩大是否导致了支付缺口，从而抵消了医院从较低的无偿医疗成本中节省的一些资金。我们审查了医院提交给美国国税局(IRS)的文件-这是为数不多的关于无偿医疗成本和医疗补助支付缺口的国家数据公开来源之一。我们还比较了扩张州和非扩张州医院的未补偿医疗费用和医疗补助支付缺口的变化。我们的发现表明，州医疗补助的扩大导致医院的无偿护理成本大幅减少，但节省的费用在一定程度上被医疗补助支付缺口的增加所抵消。因此，只关注减少无偿医疗费用的研究可能会夸大扩大医疗补助对医院财务的好处。
The Patient Protection and Affordable Care Act's insurance reforms were expected to have significant and positive implications for hospital finances. In particular, state expansion of Medicaid programs held the promise of reducing hospitals' uncompensated care costs as a result of expanding health insurance to many previously uninsured individuals. Recent research indicates that in the early phases of Medicaid expansion, many hospitals did experience a substantial decline in uncompensated care costs. However, studies to date have not considered whether Medicaid expansion resulted in payment shortfalls that offset some of what hospitals saved from lower uncompensated care costs. We examined filings submitted by hospitals to the Internal Revenue Service (IRS)-one of the few publicly available sources of national data on both uncompensated care costs and Medicaid payment shortfalls. We also compared changes in uncompensated care costs and Medicaid payment shortfalls for hospitals in expansion states with those in nonexpansion states. Our findings indicate that state expansion of Medicaid led to substantial reductions in hospitals' uncompensated care costs, but the savings were offset somewhat by increased Medicaid payment shortfalls. Therefore, studies that focus only on reductions in uncompensated care costs can overstate the benefits of Medicaid expansion on hospitals finances.