Hernandez-Boussard Tina, Burns Carson S, Wang N Ewen, Baker Laurence C, Goldstein Benjamin A
Tina Hernandez-Boussard (
Carson S. Burns is a medical student at the Stanford University School of Medicine.
Health Aff (Millwood). 2014 Sep;33(9):1648-54. doi: 10.1377/hlthaff.2014.0103.
The Affordable Care Act (ACA) extended eligibility for health insurance for young adults ages 19-25. This extension may have affected how young adults use emergency department (ED) care and other health services. To test the impact of the ACA on how young adults used ED services, we used 2009-11 state administrative records from California, Florida, and New York to compare changes in ED use in young adults ages 19-25 before and after the ACA provision was implemented with changes in the same period for people ages 26-31 (the control group). Following implementation of the ACA provision, the younger group had a decrease of 2.7 ED visits per 1,000 people compared to the older group--a relative change of -2.1 percent. The largest relative decreases were found in women (-3.0 percent) and blacks (-3.4 percent). This relative decrease in ED use implies a total reduction of more than 60,000 visits from young adults ages 19-25 across the three states in 2011. When we compared the probability of ever using the ED before and after implementation of the ACA provision, we found a minimal decrease (-0.4 percent) among the younger group compared to the older group. This suggests that the change in the number of visits was driven by fewer visits among ED users, not by changes in the number of people who ever visited the ED.
《平价医疗法案》（ACA）扩大了19至25岁年轻人的医疗保险资格。这一扩大可能影响了年轻人使用急诊科（ED）护理及其他医疗服务的方式。为了测试ACA对年轻人使用ED服务方式的影响，我们使用了加利福尼亚州、佛罗里达州和纽约州2009 - 2011年的州行政记录，将ACA条款实施前后19至25岁年轻人的ED使用变化与26至31岁人群（对照组）同期的变化进行比较。ACA条款实施后，较年轻组每1000人急诊就诊次数比年长组减少了2.7次——相对变化为-2.1%。相对减少幅度最大的是女性（-3.0%）和黑人（-3.4%）。ED使用的这种相对减少意味着2011年这三个州19至25岁的年轻人急诊就诊总次数减少了60000多次。当我们比较ACA条款实施前后使用过ED的概率时，我们发现较年轻组与年长组相比有极小的下降（-0.4%）。这表明就诊次数的变化是由ED使用者就诊次数减少导致的，而非曾经去过ED的人数变化。
