Department of Economics, Indiana University-Purdue University Indianapolis, Indianapolis, IN.
School of Public and Environmental Affairs, Indiana University, Bloomington, IN; Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.
Ann Emerg Med. 2015 Jun;65(6):664-672.e2. doi: 10.1016/j.annemergmed.2015.01.010. Epub 2015 Mar 10.
Since September 2010, the Patient Protection and Affordable Care Act has allowed young adults to remain as dependents on their parents' private health plans until age 26 years. This insurance expansion could improve the efficiency of medical care delivery by reducing unnecessary emergency department (ED) use. We evaluated the effect of this provision on ED use among young adults.
We used a nationally representative ED visit database of more than 17 million visits from 2007 to 2011. Our analysis compared young adults aged 19 to 25 years (the age group targeted by the law) with slightly older adults aged 27 to 29 years (control group), before and after the implementation of the law.
The quarterly ED-visit rate decreased by 1.6 per 1,000 population (95% confidence interval 1.2 to 2.1) among targeted young adults after the implementation of the provision, relative to a comparison group. The decrease was concentrated among women, weekday visits, nonurgent conditions, and conditions that can be treated in other settings. We found no effect among weekend visits or visits due to injuries or urgent conditions. The provision also changed the health insurance composition of ED visits; the fraction of privately insured young adults increased, whereas the fraction of those insured through Medicaid and those uninsured decreased.
The Patient Protection and Affordable Care Act dependent coverage expansion was associated with a statistically significant yet modest decrease in ED use, concentrated in the types of ED visits that were likely to be responsive to changes to insurance status. In response to the law, young adults appeared to have altered their visit pattern to reflect a more efficient use of medical care.
自 2010 年 9 月以来，《患者保护与平价医疗法案》允许年轻人在 26 岁之前继续依赖父母的私人医疗保险。这一保险范围的扩大可以通过减少不必要的急诊（ED）就诊来提高医疗服务的效率。我们评估了这一规定对年轻人 ED 使用的影响。
我们使用了一个全国性的 ED 就诊数据库，其中包括 2007 年至 2011 年期间超过 1700 万次就诊。在该法律实施前后，我们将 19 至 25 岁（该法律针对的年龄组）的年轻成年人与稍年长的 27 至 29 岁的成年人（对照组）进行了比较。
与对照组相比，在该规定实施后，目标年轻成年人的每千人季度 ED 就诊率下降了 1.6（95%置信区间为 1.2 至 2.1）。这种下降主要集中在女性、工作日就诊、非紧急情况以及可以在其他场所治疗的情况。我们没有发现周末就诊或因受伤或紧急情况就诊的情况有任何影响。该规定还改变了 ED 就诊的医疗保险构成；私人保险的年轻成年人比例增加，而通过医疗补助和无保险获得保险的年轻人比例下降。
《患者保护与平价医疗法案》的受抚养人保险范围扩大与 ED 使用的统计学显著但适度下降有关，主要集中在对保险状况变化可能有反应的 ED 就诊类型上。为了应对该法律，年轻人似乎改变了他们的就诊模式，以反映出更有效的医疗保健利用。
