Harvard Medical School, Boston, Massachusetts, USA.
Health Aff (Millwood). 2013 Mar;32(3):571-8. doi: 10.1377/hlthaff.2012.1018.
Critics of Massachusetts's health reform, a model for the Affordable Care Act, have argued that insurance expansion probably had a negative spillover effect leading to worse outcomes among already insured patients, such as vulnerable Medicare patients. Using Medicare data from 2004 to 2009, we examined trends in preventable hospitalizations for conditions such as uncontrolled hypertension and diabetes--markers of access to effective primary care--in Massachusetts compared to control states. We found that after Massachusetts's health reform, preventable hospitalization rates for Medicare patients actually decreased more in Massachusetts than in control states (a reduction of 101 admissions per 100,000 patients per quarter compared to a reduction of 83 admissions). Therefore, we found no evidence that Massachusetts's insurance expansion had a deleterious spillover effect on preventable hospitalizations among the previously insured. Our findings should offer some reassurance that it is possible to expand access to uninsured Americans without negatively affecting important clinical outcomes for those who are already insured.
马萨诸塞州的医疗改革是平价医疗法案的典范，其批评者认为，保险范围的扩大可能产生了负面的溢出效应，导致已有保险的患者（如弱势的医疗保险患者）的治疗结果恶化。我们利用 2004 年至 2009 年的医疗保险数据，在马萨诸塞州和对照州之间，检查了可预防性住院的趋势，如未得到控制的高血压和糖尿病等情况，这些都是有效初级保健的指标。我们发现，在马萨诸塞州的医疗改革之后，医疗保险患者的可预防性住院率实际上在马萨诸塞州比在对照州下降得更多（每 10 万患者每季度减少 101 例住院，而减少 83 例住院）。因此，我们没有发现马萨诸塞州保险范围扩大对以前参保者的可预防性住院产生有害溢出效应的证据。我们的研究结果应该可以让人放心，即扩大对未参保美国人的医疗服务覆盖范围而不影响那些已有保险的人的重要临床结果是可能的。
