Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States.
Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States.
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DOI：
10.1097/mlr.0000000000001523
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发表时间：
2021-07-01
期刊：
影响因子：
3
通讯作者：
Yu H
中科院分区：
文献类型：
--
作者：
Escarce JJ;Wozniak GD;Tsipas S;Pane JD;Brotherton SE;Yu H
补充数字内容可在文本中找到。一些州根据《平价医疗法案》扩大了医疗补助计划，提高了低收入居民对医疗保健的需求，而其他州则选择不扩大。本研究的目的是确定医疗补助计划的扩大是否影响了刚刚完成研究生医学教育的医生选择的州，以建立他们的第一个实践。使用2009-2019年美国医学会医师主文件的数据和各州医疗补助扩展状态的信息，我们估计了条件logit模型，以比较新医生在扩展实施后6年内的位置与他们在实施前5年内的位置。样本由8个专业组的160，842名医生组成。到研究期结束时，33个州和哥伦比亚特区扩大了医疗补助计划。与扩张前的模式相比，我们发现，医生在一个专业组-一般内科-越来越有可能在扩张后的时间，位于扩张状态。医疗补助的扩张影响了男性和国际医学毕业生在普通内科的实践地点选择;女性和美国医学毕业生没有改变他们的扩张前的位置模式。模拟估计，在2014年至2019年期间，非扩张状态失去了310名普通内科医生（95%置信区间，156-464）。医疗补助的扩大影响了新的普通内科医生的实践地点的选择。根据《平价医疗法案》选择不扩大医疗补助的州将普通内科医生输给了扩大州，这可能会影响所有居民获得医疗服务的机会，无论他们的保险范围如何。
Supplemental Digital Content is available in the text. Some states expanded Medicaid under the Affordable Care Act, boosting their low-income residents’ demand for health care, while other states opted not to expand. The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices. Using 2009–2019 data from the American Medical Association Physician Masterfile and information on states’ Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following implementation of the expansion to where they located during the 5 years preceding implementation. The sample consisted of 160,842 physicians in 8 specialty groups. Thirty-three states and the District of Columbia expanded Medicaid by the end of the study period. Compared with preexpansion patterns, we found that physicians in one specialty group—general internal medicine—were increasingly likely to locate in expansion states with time after the expansion. The Medicaid expansion influenced the practice location choices of men and international medical graduates in general internal medicine; women and United States medical graduates did not alter their preexpansion location patterns. Simulations estimated that, between 2014 and 2019, nonexpansion states lost 310 general internists (95% confidence interval, 156–464) to expansion states. The Medicaid expansion influenced the practice location choices of new general internists. States that opted not to expand Medicaid under the Affordable Care Act lost general internists to expansion states, potentially affecting access to care for all their residents irrespective of insurance coverage.