Reiter Kristin L, Noles Marissa, Pink George H
Kristin L. Reiter (
Marissa Noles is senior consultant for Deloitte Consulting LLP, in Charlotte, North Carolina. She was a research assistant in the Cecil G. Sheps Center for Health Services Research at UNC at Chapel Hill.
Health Aff (Millwood). 2015 Oct;34(10):1721-9. doi: 10.1377/hlthaff.2014.1340.
The implementation of the Affordable Care Act has led to a large decrease in the number of uninsured people. Yet uncompensated care will still occur, particularly in states where eligibility for Medicaid is not expanded. We compared rural hospitals in Medicaid expansion and nonexpansion states in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013. We found that rural hospitals in expansion states provided more dollars of uncompensated care than those in nonexpansion states and that the difference was at least partly driven by greater uncompensated costs associated with public programs such as Medicaid. We found higher dollar values of unrecoverable debt and charity care among non-critical access rural hospitals in nonexpansion states than among those in expansion states. Compared to hospitals in expansion states, those in nonexpansion states provided greater amounts of uncompensated care as a percentage of revenues and appeared to be more financially vulnerable; thus, these hospitals may be more likely to experience financial pressure or losses. Policy makers need to formulate strategies for maintaining access to care for rural populations residing in nonexpansion states.
《平价医疗法案》的实施已导致未参保人数大幅减少。然而，无偿医疗仍会出现，尤其是在医疗补助资格未扩大的州。我们比较了2013年医疗补助扩大州和未扩大州的农村医院在无偿医疗提供量、盈利能力及市场特征方面的情况。我们发现，扩大州的农村医院提供的无偿医疗资金比未扩大州的更多，且这种差异至少部分是由与医疗补助等公共项目相关的更高无偿成本所驱动。我们发现，未扩大州的非关键接入农村医院的无法收回债务和慈善医疗的资金价值高于扩大州的此类医院。与扩大州的医院相比，未扩大州的医院将更高比例的收入用于提供无偿医疗，且似乎在财务上更脆弱；因此，这些医院可能更易面临财务压力或亏损。政策制定者需要制定策略，以确保未扩大州农村人口能够获得医疗服务。
