DuBard C Annette, Massing Mark W
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA.
JAMA. 2007 Mar 14;297(10):1085-92. doi: 10.1001/jama.297.10.1085.
Undocumented immigrants and legal immigrants who have been in the United States less than 5 years are excluded from Medicaid eligibility, with the exception of limited coverage for emergency conditions (Emergency Medicaid). New immigrant population growth has been rapid in recent years, but little is known about use of health services by this group or the conditions for which Emergency Medicaid coverage has been applied.
To describe Emergency Medicaid use by recent and undocumented immigrants including patient characteristics, diagnoses, and recent spending trends in North Carolina, a state with a rapidly increasing population of undocumented immigrants.
DESIGN, SETTING, AND PATIENTS: Descriptive analysis of North Carolina Medicaid administrative data for all claims reimbursed under Emergency Medicaid eligibility criteria 2001 through 2004 in North Carolina, a state with high immigration from Mexico and Latin America. Patients are recent and undocumented immigrants who meet categorical and income criteria for Medicaid coverage, but are excluded from full coverage due to legal status.
Patient characteristics, hospitalizations, diagnoses, and Medicaid spending for emergency care.
A total of 48,391 individuals received services reimbursed under Emergency Medicaid during the 4-year period of this study. The patient population was 99% undocumented, 93% Hispanic, 95% female, and 89% in the 18- to 40-year age group. Total spending increased by 28% from 2001 through 2004, with more rapid spending increases among elderly (98%) and disabled (82%) patients. In 2004, childbirth and complications of pregnancy accounted for 82% of spending and 91% of hospitalizations. Injury, renal failure, gastrointestinal disease, and cardiovascular conditions were also prevalent.
Childbirth and complications of pregnancy account for the majority of Emergency Medicaid spending for undocumented immigrants in North Carolina. Spending for elderly and disabled patients, however, is increasing at a faster rate. Among nonpregnant immigrants, injuries, other acute emergencies, and severe complications of chronic disease are major contributors to Emergency Medicaid use.
未登记的移民以及在美国居住时间少于5年的合法移民无资格享受医疗补助，但紧急情况（紧急医疗补助）的有限覆盖范围除外。近年来新移民人口增长迅速，但对于该群体的医疗服务使用情况以及紧急医疗补助覆盖的适用条件了解甚少。
描述近期及未登记移民的紧急医疗补助使用情况，包括患者特征、诊断情况以及北卡罗来纳州的近期支出趋势，该州未登记移民人口增长迅速。
设计、地点和患者：对北卡罗来纳州医疗补助管理数据进行描述性分析，这些数据涵盖了2001年至2004年期间根据紧急医疗补助资格标准报销的所有索赔。北卡罗来纳州有大量来自墨西哥和拉丁美洲的移民。患者为近期及未登记移民，他们符合医疗补助覆盖的类别和收入标准，但因法律身份被排除在全面覆盖范围之外。
患者特征、住院情况、诊断以及紧急护理的医疗补助支出。
在本研究的4年期间，共有48391人接受了根据紧急医疗补助报销的服务。患者群体中99%为未登记移民，93%为西班牙裔，95%为女性，89%年龄在18至40岁之间。从2001年到2004年，总支出增长了28%，老年患者（98%）和残疾患者（82%）的支出增长更为迅速。2004年，分娩及妊娠并发症占支出的82%，占住院的91%。损伤、肾衰竭、胃肠道疾病和心血管疾病也很普遍。
分娩及妊娠并发症占北卡罗来纳州未登记移民紧急医疗补助支出的大部分。然而，老年和残疾患者的支出增长速度更快。在非妊娠移民中，损伤、其他急性紧急情况和慢性病的严重并发症是紧急医疗补助使用的主要原因。
