From the Perelman School of Medicine (D.P., S.B., K.V.R.) and the Leonard Davis Institute of Health Economics (D.P., M.R., K.V.R.), University of Pennsylvania, Philadelphia; and the Urban Institute, Washington, DC (D.W., G.M.K., S.Z.).
N Engl J Med. 2015 Feb 5;372(6):537-45. doi: 10.1056/NEJMsa1413299. Epub 2015 Jan 21.
Providing increases in Medicaid reimbursements for primary care, a key provision of the Affordable Care Act (ACA), raised Medicaid payments to Medicare levels in 2013 and 2014 for selected services and providers. The federally funded increase in reimbursements was aimed at expanding access to primary care for the growing number of Medicaid enrollees. The reimbursement increase expired at the end of 2014 in most states before policymakers had much empirical evidence about its effects.
We measured the availability of and waiting times for appointments in 10 states during two periods: from November 2012 through March 2013 and from May 2014 through July 2014. Trained field staff posed as either Medicaid enrollees or privately insured enrollees seeking new-patient primary care appointments. We estimated state-level changes over time in a stable cohort of primary care practices that participated in Medicaid to assess whether willingness to provide appointments for new Medicaid enrollees was related to the size of increases in Medicaid reimbursements in each state.
The availability of primary care appointments in the Medicaid group increased by 7.7 percentage points, from 58.7% to 66.4%, between the two time periods. The states with the largest increases in availability tended to be those with the largest increases in reimbursements, with an estimated increase of 1.25 percentage points in availability per 10% increase in Medicaid reimbursements (P=0.03). No such association was observed in the private-insurance group. During the same periods, waiting times to a scheduled new-patient appointment remained stable over time in the two study groups.
Our study provides early evidence that increased Medicaid reimbursement to primary care providers, as mandated in the ACA, was associated with improved appointment availability for Medicaid enrollees among participating providers without generating longer waiting times. (Funded by the Robert Wood Johnson Foundation.).
平价医疗法案（ACA）的一项重要规定是增加医疗补助计划（Medicaid）对初级保健的报销，这在 2013 年和 2014 年提高了选定服务和提供者的医疗补助支付水平，使其达到医疗保险（Medicare）的水平。联邦政府增加报销的目的是为了让越来越多的医疗补助计划受保人更容易获得初级保健。在决策者对其效果有太多经验证据之前，这种报销增加在大多数州于 2014 年底到期。
我们在两个时期测量了 10 个州的预约可用性和等待时间：2012 年 11 月至 2013 年 3 月，以及 2014 年 5 月至 2014 年 7 月。经过培训的实地工作人员分别以医疗补助计划受保人和私人保险受保人的身份，申请新病人初级保健预约。我们评估了参与医疗补助计划的初级保健实践的稳定队列中各州随时间的变化，以确定为新的医疗补助计划受保人提供预约的意愿是否与各州医疗补助计划报销增加的幅度有关。
在这两个时期，医疗补助组的初级保健预约可用性增加了 7.7 个百分点，从 58.7%增加到 66.4%。可用性增加幅度最大的州往往是报销增加幅度最大的州，每增加 10%的医疗补助报销，可用性估计增加 1.25 个百分点（P=0.03）。在私人保险组中没有观察到这种关联。在同期，两个研究组的新病人预约的等待时间在这段时间内保持稳定。
我们的研究提供了早期证据，表明按照平价医疗法案的要求增加对初级保健提供者的医疗补助报销与参与提供者为医疗补助计划受保人提供的预约可用性提高有关，而没有导致更长的等待时间。（由罗伯特伍德约翰逊基金会资助）。
