Financial impacts of the Medicaid expansion on community health centers.
Financial impacts of the Medicaid expansion on community health centers.
复制标题
医疗补助扩大对社区卫生中心的财务影响。
DOI：
10.1111/1475-6773.13897
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发表时间：
2022
影响因子：
3.4
通讯作者：
Dor,Avi
中科院分区：
文献类型：
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作者：
Luo,Qian;Moghtaderi,Ali;Markus,Anne;Dor,Avi
目的确定医疗补助计划扩大对联邦资助的社区卫生中心的收入、成本、资产和负债的影响。数据来源我们结合了统一数据系统、美国国税局非营利纳税申报表和人口普查局的县级特征数据。我们的最终数据集包括5841个中心年观察结果。研究设计我们使用差异中的差异模型来估计医疗补助扩张对社区卫生中心的财政影响。我们采用事件研究模型、特定状态趋势模型和安慰剂法检验作为稳健性检查。数据收集方法主要发现在收入方面，我们发现医疗补助收入相对增加208万（p=0.002），与非扩张州的中心相比，扩张州的社区卫生中心的总赠款减少了44万（p= 0.015）。在支出方面，我们发现扩张州的医疗中心总支出大幅增加（p=0.201），但在统计学上并不显著。与非扩张州相比，扩张州的医疗中心的无补偿护理减少了119万（p< 0.001）。结论：扩张状态的社区卫生中心受益于医疗补助扩张带来的稳定收入流。虽然医疗补助收入增加的政策的结果，我们没有发现替代远离其他收入线的主要证据，有一个显着的例外（即，替代远离州和地方政府的赠款）。从政策的角度来看，这些结果是令人鼓舞的，因为拜登政府开始实施2021年美国救援计划法案的安全网增强措施，并且越来越多的非扩张州正在考虑选择医疗补助扩张。预计这些增加的收入流将有助于维持卫生中心向服务不足的人口提供卫生保健服务。
Objective To determine the impacts of the Medicaid expansion on revenues, costs, assets, and liabilities of federally funded community health centers. Data sources We combined data from the Uniform Data System, Internal Revenue Service nonprofit tax returns, and county‐level characteristics from the Census Bureau. Our final dataset included 5841 center‐year observations. Study design We used difference‐in‐differences model to estimate the fiscal impacts of the Medicaid expansion on community health centers. We employed event study models, state‐specific trend models, and placebo law tests as robustness checks. Data collection methods Not applicable. Principal findings On the revenue side, we found a 2.08millionrelativeincrease(p=0.002)inMedicaidrevenues,offsetbya 0.44 million decrease (p= 0.015) in total grants among community health centers in expansion states compared with centers in non‐expansion states. On the expenditure side, we found a large but not statistically significant 0.98millionrelativeincrease(p=0.201)intotalexpendituresamongcentersinexpansionstates.Uncompensatedcareforhealthcentersinexpansionstatesdecreasedby 1.19 million (p< 0.001) relative to their counterparts in non‐expansion states. Conclusions Community health centers in expansion states benefited from the increased, stable revenue stream from Medicaid expansions. While Medicaid revenue increased as a result of the policy, we find no major evidence of substitution away from other revenue lines, with one notable exception (ie, substitution away from state and local government grants). From a policy perspective, these results are encouraging as the Biden Administration starts to implement the safety‐net enhancements from the American Rescue Plan Act of 2021 and as more non‐expansion states are considering opting into Medicaid expansions. It is anticipated that these added revenue streams will help to sustain health centers in the delivery of health care services to the underserved population.