Tipirneni Renuka, Rhodes Karin V, Hayward Rodney A, Lichtenstein Richard L, Choi HwaJung, Arntson Emily K, Landgraf Jessica M, Davis Matthew M
1 University of Michigan, Ann Arbor, MI, USA.
2 Northwell Health, Office of Population Health Management, Manhasset, NY, USA.
Med Care Res Rev. 2018 Oct;75(5):633-650. doi: 10.1177/1077558717697750. Epub 2017 Mar 20.
Coverage and access have improved under the Affordable Care Act, yet it is unclear whether recent gains have reached those regions within states that were most in need of improved access to care. We examined geographic variation in Medicaid acceptance among Michigan primary care practices before and after Medicaid expansion in the state, using data from a simulated patient study of primary care practices. We used logistic regression analysis with time indicators to assess regional changes in Medicaid acceptance over time. Geographic regions with lower baseline (<50%) Medicaid acceptance had significant increases in Medicaid acceptance at 4 and 8 months post-expansion, while regions with higher baseline (≥50%) Medicaid acceptance did not experience significant changes in Medicaid acceptance. As state Medicaid expansions continue to be implemented across the country, policy makers should consider the local dynamics of incentives for provider participation in Medicaid.
根据《平价医疗法案》，医保覆盖范围和可及性有所改善，但目前尚不清楚近期的改善是否惠及了各州内最需要改善医疗服务可及性的地区。我们利用一项针对初级医疗实践的模拟患者研究数据，考察了密歇根州医疗补助扩大前后该州初级医疗实践中医疗补助接受情况的地理差异。我们使用带有时间指标的逻辑回归分析来评估医疗补助接受情况随时间的区域变化。基线医疗补助接受率较低（<50%）的地理区域在扩大后4个月和8个月时医疗补助接受率显著增加，而基线医疗补助接受率较高（≥50%）的区域医疗补助接受情况没有显著变化。随着各州继续在全国范围内实施医疗补助扩大计划，政策制定者应考虑影响医疗服务提供者参与医疗补助计划的当地激励因素动态。
