Castel Liana D, Timbie Justin W, Sendersky Veronica, Curtis Lesley H, Feather Keith A, Schulman Kevin A
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715 USA.
BMC Health Serv Res. 2003 Jan 10;3(1):1. doi: 10.1186/1472-6963-3-1.
The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States.
We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey); percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals); and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute). We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals) in both univariate and multivariable regression analyses.
When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state.
Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources.
1996年的《个人责任与工作机会协调法案》（PRWORA）赋予各州从大多数合法移民中取消非紧急医疗补助覆盖范围的选择权。我们的目标是评估PRWORA对美国医院未获补偿医疗的影响。
我们收集了1994年至1999年期间以下州级数据：外国出生的非公民人口和健康未参保率（美国人口普查局当前人口调查）；教学医院的百分比（美国医院协会医院年度调查）；以及每个州关于是否对合法永久居民实施PRWORA医疗补助禁令或继续使用州自有资金提供非紧急医疗补助覆盖范围的决定（城市研究所）。我们在单变量和多变量回归分析中对各州的未获补偿医疗支出进行建模（同样来自医院年度调查）。
在州层面进行衡量时，未获补偿医疗支出与非公民移民在各州人口中的百分比之间没有显著关系。未参保率是预测各州未获补偿医院医疗支出的唯一显著因素。
减少未参保患者数量肯定会最大程度降低医院未获补偿医疗的支出。然而，数据限制阻碍了我们专门针对PRWORA中移民资格变化导致的医院财务损失进行货币估计的努力。量化这些条款对医院的影响将需要更好的数据来源。
