University of Louisville Department of Surgery, Louisville, KY, USA.
University of Louisville Department of Surgery, Louisville, KY, USA.
Am J Surg. 2019 Sep;218(3):584-589. doi: 10.1016/j.amjsurg.2019.01.013. Epub 2019 Jan 24.
In January 2014, Kentucky expanded Medicaid coverage in an effort to improve access to healthcare. This study evaluated the early impact of Medicaid expansion on diagnosis and treatment of benign gallbladder disease in Kentucky.
Administrative claims data were queried for patients undergoing cholecystectomy for benign gallbladder disease between 2011 and 2015. Demographic, procedure, and outcome variables from 2011 to 2013 (PRE) and 2014-2015 (POST) were compared.
After Medicaid expansion, patients were more likely to have their operation performed as an outpatient (80.0% vs. 78.2%, p < 0.001). A significant trend was noted toward a shorter hospital stay (p < 0.001) among inpatients. For both inpatients and outpatients, a significant shift was noted toward increased hospital charges (p < 0.001).
The expansion of Kentucky Medicaid in 2014 has been associated with an increase in outpatient cholecystectomy, shorter hospital stays for inpatients, and increased hospital charges for both inpatients and outpatients. Increased charges for all procedures may represent a mechanism for hospitals to offset the cost of providing global care for more patients.
2014 年 1 月，肯塔基州扩大了医疗补助计划的覆盖范围，以努力改善医疗保健的可及性。本研究评估了医疗补助计划扩大对肯塔基州良性胆囊疾病的诊断和治疗的早期影响。
对 2011 年至 2015 年期间因良性胆囊疾病接受胆囊切除术的患者的行政索赔数据进行了查询。比较了 2011 年至 2013 年（PRE）和 2014 年至 2015 年（POST）的人口统计学、手术和结果变量。
在医疗补助计划扩大后，患者更有可能作为门诊患者接受手术（80.0%比 78.2%，p < 0.001）。住院患者的住院时间明显缩短（p < 0.001）。对于住院患者和门诊患者，住院费用显著增加（p < 0.001）。
肯塔基州 2014 年扩大医疗补助计划与门诊胆囊切除术的增加、住院患者住院时间的缩短以及住院和门诊患者的住院费用增加有关。所有手术费用的增加可能代表医院为更多患者提供全球医疗服务而抵消成本的一种机制。
