近年来，平价医疗法案对胃肠道、胰腺和肝脏疾病的急诊科就诊和住院情况的影响及趋势。
Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases.
机构信息
Division of Gastroenterology & Hepatology, Stanford University Medical Center, Palo Alto.
Institute of Clinical Outcomes Research and Education (ICORE), Woodside, CA.
出版信息
J Clin Gastroenterol. 2020 Mar;54(3):e21-e29. doi: 10.1097/MCG.0000000000001102.
BACKGROUND
The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases.
METHODS
We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not).
RESULTS
From 2009 to 2013, GI/pancreatic/liver disease ED visits increased by 15.0% in California and 20.2% in Florida and hospitalizations for these conditions decreased by 2.6% in California and increased by 7.9% in Florida. Following Medicaid expansion, a shift from self-pay/uninsured to Medicaid insurance was seen California; in addition, a new decrease in ED visits for nausea/vomiting and GI infections, was evident, without associated change in overall ED/hospital utilization trends. Total hospitalization charges for abdominal pain, nausea/vomiting, constipation, and GI infection diagnoses decreased in California following Medicaid expansion, but increased over the same time-period in Florida.
CONCLUSIONS
We observed a striking payer shift for GI/pancreatic/liver disease ED visits/hospitalizations after Medicaid expansion in California, indicating a shift in the reimbursement burden in self-pay/uninsured patients, from patients and hospitals to the government. ED visits and hospitalization charges decreased for some primary care-treatable GI diagnoses in California, but not for Florida, suggesting a trend toward lower cost of gastroenterology care, perhaps because of decreased hospital utilization for conditions amenable to outpatient management.
背景
平价医疗法案（ACA）于 2014 年实施，扩大了医疗补助范围，为超过 2000 万以前没有保险的人提供了医疗保险。然而，尚不清楚扩大医疗补助范围是否增加了初级保健服务的可及性，从而减少了胃肠道（GI）/胰腺/肝脏疾病的急诊（ED）就诊和住院治疗。
方法
我们评估了在扩大医疗补助范围之前的 5 年期间以及扩大范围后的一年中，加利福尼亚州（实施了医疗补助扩大的州）和佛罗里达州（未实施医疗补助扩大的州）GI/胰腺/肝脏疾病特定 ED/住院诊断的利用趋势，并对其进行了比较。
结果
从 2009 年到 2013 年，加利福尼亚州的 GI/胰腺/肝脏疾病 ED 就诊量增加了 15.0%，佛罗里达州增加了 20.2%，而这些疾病的住院治疗量在加利福尼亚州减少了 2.6%，在佛罗里达州增加了 7.9%。在医疗补助扩大之后，加利福尼亚州出现了从自付/无保险向医疗补助保险转变的情况；此外，恶心/呕吐和 GI 感染的 ED 就诊量明显减少，而 ED/住院治疗总利用趋势没有变化。在医疗补助扩大之后，加利福尼亚州腹痛、恶心/呕吐、便秘和 GI 感染诊断的住院总费用减少了，但在同一时期佛罗里达州却增加了。
结论
我们观察到加利福尼亚州医疗补助扩大后 GI/胰腺/肝脏疾病 ED 就诊/住院治疗的支付方式发生了显著变化，表明自付/无保险患者的报销负担从患者和医院转移到了政府。加利福尼亚州一些初级保健治疗的 GI 诊断的 ED 就诊和住院费用有所下降，但佛罗里达州却没有，这表明胃肠病学治疗费用呈下降趋势，这可能是由于对适合门诊管理的疾病的住院利用率降低。
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