STATE MEDICAID EXPANSIONS AND MORTALITY, REVISITED: A COST-BENEFIT ANALYSIS
STATE MEDICAID EXPANSIONS AND MORTALITY, REVISITED: A COST-BENEFIT ANALYSIS
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DOI：
10.1162/ajhe_a_00080
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发表时间：
2017-06-01
影响因子：
3.7
通讯作者：
Sommers, Benjamin D.
中科院分区：
文献类型：
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作者：
Sommers, Benjamin D.
先前的研究发现，2000 年代初期纽约、亚利桑那州和缅因州医疗补助计划的扩张降低了死亡率。我用改进的数据和方法重新审视这个问题，探索不同的死亡原因并提出成本效益分析。使用倾向评分对照组的双重差异分析显示，全因死亡率下降了 6%，其中医疗保健原因死亡率下降幅度最大。与艾滋病毒相关的死亡率（受最近引入抗逆转录病毒药物的影响）占了 20% 的影响。死亡率变化与县级保险覆盖率的提高密切相关，每 239 至 316 名成年人获得保险，每年就能挽救 1 条生命。结果表明，每条生命节省的成本在 327,000 美元到 867,000 美元之间，这与大多数统计生命价值的估计相比是有利的。
Previous research found that Medicaid expansions in New York, Arizona, and Maine in the early 2000s reduced mortality. I revisit this question with improved data and methods, exploring distinct causes of death and presenting a cost-benefit analysis. Differences-in-differences analysis using a propensity score control group shows that all-cause mortality declined by 6 percent, with the most robust reductions for health-care amenable causes. HIV-related mortality (affected by the recent introduction of antiretrovirals) accounted for 20 percent of the effect. Mortality changes were closely linked to county-level coverage gains, with one life saved annually for every 239 to 316 adults gaining insurance. The results imply a cost per life saved ranging from $327,000 to $867,000 which compares favorably with most estimates of the value of a statistical life.