Understanding The Relationship Between Medicaid Expansions And Hospital Closures
Understanding The Relationship Between Medicaid Expansions And Hospital Closures
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DOI：
10.1377/hlthaff.2017.0976
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发表时间：
2018-01-01
期刊：
影响因子：
9.7
通讯作者：
Tung, Gregory J.
中科院分区：
文献类型：
--
作者：
Lindrooth, Richard C.;Perraillon, Marcelo C.;Tung, Gregory J.
各州关于是否根据《平价医疗法案》（ACA）扩大医疗补助的决定对医院的财务健康产生了影响。我们假设，医疗补助扩大无子女成年人的资格，防止医院关闭，因为增加医疗补助覆盖以前没有保险的人减少无偿护理支出，并加强医院的财务状况。我们使用2008- 2016年期间关于医院关闭和财务业绩的数据来检验这一假设。我们发现，ACA的医疗补助扩张与改善医院财务状况和大幅降低关闭的可能性有关，特别是在医疗补助扩张之前有大量未参保成年人的农村市场和县。未来国会改革医疗补助政策的努力应该考虑医疗补助覆盖水平和医院财务可行性之间的密切关系。我们的研究结果表明，恢复到ACA前的资格水平将导致农村医院关闭的特别大的增加。这种关闭可能导致获得护理的机会减少，高技能工作岗位流失，从而对当地经济产生不利影响。
Decisions by states about whether to expand Medicaid under the Affordable Care Act (ACA) have implications for hospitals' financial health. We hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. We tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance. We found that the ACA's Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion. Future congressional efforts to reform Medicaid policy should consider the strong relationship between Medicaid coverage levels and the financial viability of hospitals. Our results imply that reverting to pre-ACA eligibility levels would lead to particularly large increases in rural hospital closures. Such closures could lead to reduced access to care and a loss of highly skilled jobs, which could have detrimental impacts on local economies.