Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares
Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares
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DOI：
10.1111/1475-6773.12812
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发表时间：
2018-10-01
影响因子：
3.4
通讯作者：
Pickens, Gary
中科院分区：
文献类型：
--
作者：
Wu, Vivian Y.;Fingar, Kathryn R.;Pickens, Gary
目标。研究《平价医疗法案》对安全网医院（snh）覆盖范围扩大的影响。研究设置。9个扩大医疗补助的州。研究设计。差异中的差异（DID）模型比较了19-64岁成人在snh和非snh的住院时间的付款人特异性预变化。2013-2014年医疗成本与利用项目国家住院患者数据库。主要的发现。扩张后平均每个季度，snh和非snh的未保险停留时间相对减少相似（DID = - 2.2%, p = .916）。非snh患者比snh患者的医疗补助住院时间增加了更多（did = 13.8%, p = 0.041）。对于snh来说，无保险住院时间的平均减少（-146）与医疗补助住院时间的增加（153）相似；私人保险住宿保持稳定。对于非snh，无保险（-63）加上私人保险（-33）的减少与医疗补助（105）的增加相似。snh和非snh的医疗补助、无保险和私人保险住院时间的绝对增长相似（DID = -16, p = .162）。扩建后，非snh比snh的医疗补助增加了更大的百分比，这可能反映了患者选择非snh而不是snh或挤出私人保险。需要更多的研究来了解这些趋势。
Objective. To examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs).Study Setting. Nine Medicaid expansion states.Study Design. Differences-in-differences (DID) models compare payer-specific prepost changes in inpatient stays of adults aged 19-64 years at SNHs and non-SNHs.Data Collection Methods. 2013-2014 Healthcare Cost and Utilization Project State Inpatient Databases.Principal Findings. On average per quarter postexpansion, SNHs and non-SNHs experienced similar relative decreases in uninsured stays (DID = -2.2 percent, p = .916). Non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs (DID = 13.8 percent, p = .041). For SNHs, the average decrease in uninsured stays (-146) was similar to the increase in Medicaid stays (153); privately insured stays were stable. For non-SNHs, the decrease in uninsured (-63) plus privately insured (-33) stays was similar to the increase in Medicaid stays (105). SNHs and non-SNHs experienced a similar absolute increase in Medicaid, uninsured, and privately insured stays combined (DID = -16, p = .162).Conclusions. Postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance. More research is needed to understand these trends.