Barakat Monique T, Mithal Aditi, Huang Robert J, Mithal Alka, Sehgal Amrita, Banerjee Subhas, Singh Gurkirpal
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, United States of America.
Institute of Clinical Outcomes Research and Education (ICORE), Woodside, California, United States of America.
PLoS One. 2017 Aug 3;12(8):e0182346. doi: 10.1371/journal.pone.0182346. eCollection 2017.
The Affordable Care Act (ACA) has expanded access to health insurance for millions of Americans, but the impact of Medicaid expansion on healthcare delivery and utilization remains uncertain.
To determine the early impact of the Medicaid expansion component of ACA on hospital and ED utilization in California, a state that implemented the Medicaid expansion component of ACA and Florida, a state that did not.
Analyze all ED encounters and hospitalizations in California and Florida from 2009 to 2014 and evaluate trends by payer and diagnostic category. Data were collected from State Inpatient Databases, State Emergency Department Databases and the California Office of Statewide Health Planning and Development.
Hospital and ED encounters.
Population-based study of California and Florida state residents.
Implementation of Medicaid expansion component of ACA in California in 2014.
Changes in ED visits and hospitalizations by payer, percentage of patients hospitalized after an ED encounter, top diagnostic categories for ED and hospital encounters.
In California, Medicaid ED visits increased 33% after Medicaid expansion implementation and self-pay visits decreased by 25% compared with a 5.7% increase in the rate of Medicaid patient ED visits and a 5.1% decrease in rate of self-pay patient visits in Florida. In addition, California experienced a 15.4% increase in Medicaid inpatient stays and a 25% decrease in self pay stays. Trends in the percentage of patients admitted to the hospital from the ED were notable; a 5.4% decrease in hospital admissions originating from the ED in California, and a 2.1% decrease in Florida from 2013 to 2014.
We observed a significant shift in payer for ED visits and hospitalizations after Medicaid expansion in California without a significant change in top diagnoses or overall rate of these ED visits and hospitalizations. There appears to be a shift in reimbursement burden from patients and hospitals to the government without a dramatic shift in patterns of ED or hospital utilization.
《平价医疗法案》（ACA）为数百万美国人扩大了医疗保险覆盖范围，但医疗补助计划扩张对医疗服务提供和利用的影响仍不确定。
确定ACA中医疗补助计划扩张部分对加利福尼亚州（实施了ACA中医疗补助计划扩张部分的州）和佛罗里达州（未实施该计划的州）医院及急诊室利用情况的早期影响。
分析2009年至2014年加利福尼亚州和佛罗里达州的所有急诊室就诊和住院情况，并按付款方和诊断类别评估趋势。数据收集自州住院数据库、州急诊室数据库以及加利福尼亚州全州卫生规划与发展办公室。
医院和急诊室就诊。
基于加利福尼亚州和佛罗里达州居民的人群研究。
2014年加利福尼亚州实施ACA中医疗补助计划扩张部分。
按付款方划分的急诊室就诊和住院情况变化、急诊室就诊后住院患者的百分比、急诊室和医院就诊的主要诊断类别。
在加利福尼亚州，医疗补助计划扩张实施后，医疗补助计划支付的急诊室就诊次数增加了33%，自费就诊次数减少了25%；相比之下，佛罗里达州医疗补助计划患者的急诊室就诊率增加了5.7%，自费患者的就诊率下降了5.1%。此外，加利福尼亚州医疗补助计划覆盖的住院天数增加了15.4%，自费住院天数减少了25%。从急诊室入院的患者百分比趋势值得注意；2013年至2014年，加利福尼亚州急诊室引发的住院人数减少了5.4%，佛罗里达州减少了2.1%。
我们观察到，加利福尼亚州医疗补助计划扩张后，急诊室就诊和住院的付款方发生了显著变化，但主要诊断或这些急诊室就诊和住院的总体发生率没有显著变化。报销负担似乎从患者和医院转移到了政府，而急诊室或医院的利用模式没有发生巨大转变。
