Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine.
Institute for Healthcare Policy and Innovation.
Med Care. 2019 Apr;57(4):312-317. doi: 10.1097/MLR.0000000000001082.
Medicaid expansion was associated with an increase in hospitalizations funded by Medicaid. Whether this increase reflects an isolated payer shift or broader changes in case-mix among hospitalized adults remains uncertain.
Difference-in-differences analysis of discharge data from 4 states that expanded Medicaid in 2014 (Arizona, Iowa, New Jersey, and Washington) and 3 comparison states that did not (North Carolina, Nebraska, and Wisconsin).
All nonobstetric hospitalizations among patients aged 19-64 years of age admitted between January 2012 and December 2015.
Outcomes included state-level per-capita rates of insurance coverage, several markers of admission severity, and admission diagnosis.
We identified 6,516,576 patients admitted during the study period. Per-capita admissions remained consistent in expansion and nonexpansion states, though Medicaid-covered admissions increased in expansion states (274.6-403.8 per 100,000 people vs. 268.9-262.8 per 100,000; P<0.001). There were no significant differences after Medicaid expansion in hospital utilization, based on per-capita rates of patients-designated emergent, admitted via the emergency department, admitted via clinic, discharged within 1 day, or with lengths of stay ≥7 days. Similarly, there were no differences in diagnosis category at admission, admission severity, comorbidity burden, or mortality associated with Medicaid expansion (P>0.05 for all comparisons).
Medicaid expansion was associated with a shift in payers among nonelderly hospitalized adults without significant changes in case-mix or in several markers of acuity. These findings suggest that Medicaid expansion may reduce uncompensated care without shifting admissions practices or acuity among hospitalized adults.
医疗补助计划的扩大与医疗补助计划资助的住院人数增加有关。这种增加是否反映了孤立的付款人转移，还是住院成年人病例组合的更广泛变化仍不确定。
对 2014 年扩大医疗补助计划的 4 个州（亚利桑那州、爱荷华州、新泽西州和华盛顿州）和 3 个未扩大医疗补助计划的比较州（北卡罗来纳州、内布拉斯加州和威斯康星州）的出院数据进行差异分析。
19-64 岁患者在 2012 年 1 月至 2015 年 12 月期间的所有非产科住院治疗。
包括州级保险覆盖率、入院严重程度的几个指标和入院诊断。
研究期间共确定了 6516576 名患者入院。虽然在扩大和未扩大医疗补助计划的州中，每 100000 人中有 274.6-403.8 人（P<0.001）的住院人数保持不变，但扩大医疗补助计划的州中 Medicaid 覆盖的住院人数增加了。在扩大 Medicaid 后，根据患者指定的紧急情况、通过急诊室入院、通过诊所入院、在 1 天内出院或住院时间≥7 天的人均住院率，医院利用方面没有显著差异。同样，在入院时的诊断类别、入院严重程度、合并症负担或与 Medicaid 扩张相关的死亡率方面也没有差异（所有比较 P>0.05）。
Medicaid 计划的扩大与非老年住院成年人的付款人转移有关，而病例组合或几种严重程度指标没有明显变化。这些发现表明， Medicaid 计划的扩大可能会减少无补偿护理，而不会改变住院成年人的入院实践或严重程度。
