Department of Family Medicine, Oregon Health and Science University.
School of Public Health, Oregon Health and Science University-Portland State University.
Med Care. 2018 May;56(5):394-402. doi: 10.1097/MLR.0000000000000907.
There is interest in assessing health care utilization and expenditures among new Medicaid enrollees after the 2014 Medicaid expansion. Recent studies have not differentiated between newly enrolled individuals and those returning after coverage gaps.
To assess health care expenditures among Medicaid enrollees in the 24 months after Oregon's 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured (CI).
Retrospective cohort study using inverse-propensity weights to adjust for differences between groups.
Oregon adult Medicaid beneficiaries insured continuously from 2014 to 2015 who were either newly, returning, or CI.
Monthly expenditures for inpatient care, prescription drugs, total outpatient care, and subdivisions of outpatient care: emergency department, dental, mental and behavioral health, primary care, and specialist care.
After initial increases, newly and returning insured (RI) outpatient expenditures dropped below CI. Expenditures for emergency department and dental services among the RI remained higher than among the newly insured. Newly insured mental and behavioral health, primary care, and specialist expenditures plateaued higher than RI. Prescription drug expenditures increased over time for all groups, with CI highest and RI lowest. All groups had similar inpatient expenditures over 24 months post-Medicaid expansion.
Our findings reveal that outpatient expenditures for new nonpregnant, non-dual-eligible Oregon Medicaid recipients stabilized over time after meeting pent-up demand, and prior insurance history affected the mix of services that individuals received. Policy evaluations should consider expenditures over at least 24 months and should account for enrollees' prior insurance histories.
自 2014 年扩大医疗补助计划以来，人们对评估新入保者的医疗保健利用和支出情况产生了兴趣。最近的研究并未区分新入保者和有保险覆盖缺口后重新入保者。
评估俄勒冈州 2014 年扩大医疗补助计划后 24 个月内医疗补助受保者的医疗保健支出情况，并研究新入保者、重新入保者和持续保险者（CI）的支出模式是否存在差异。
采用逆倾向评分法进行回顾性队列研究，以调整组间差异。
俄勒冈州成年医疗补助受保者，2014 年至 2015 年连续参保，分为新入保者、重新入保者和 CI。
住院护理、处方药、总门诊护理和门诊护理细分项（急诊、牙科、精神和行为健康、初级保健和专科保健）的每月支出。
新入保者和重新入保者（RI）的门诊支出在最初增加后下降到 CI 以下。RI 急诊和牙科服务支出仍高于新入保者。新入保者的精神和行为健康、初级保健和专科保健支出水平高于 RI。所有组的处方药支出随着时间的推移而增加，CI 组最高，RI 组最低。所有组在扩大医疗补助计划后 24 个月内的住院支出相似。
我们的研究结果表明，满足积压需求后，新非怀孕、非双重资格的俄勒冈州医疗补助受保者的门诊支出随时间稳定下来，且既往保险史影响了个人接受服务的组合。政策评估应考虑至少 24 个月的支出，并应考虑到参保者的既往保险史。
