Carnegie Mellon University, Pittsburgh, PA, USA.
RAND Corporation, Pittsburgh, PA, USA.
Med Care Res Rev. 2021 Feb;78(1):24-35. doi: 10.1177/1077558719848270. Epub 2019 May 27.
We examine changes in emergency department (ED) visit acuity and care intensity for uninsured patients who gained Medicaid insurance in 2014 under the Patient Protection and Affordable Care Act. We use 2013-2015 longitudinal patient visit-level data from 30 EDs across 7 states from an emergency medicine group. We examine changes in ED use by previously uninsured Medicaid patients and patients remaining uninsured who were repeat ED users (≥1 visit before and after expansion) using a propensity-score weighted approach with statistical machine learning to estimate the weights. Compared with those remaining uninsured in nonexpansion states, newly covered Medicaid patients in expansion states showed a 29% relative increase in hospital admissions and 32% increase in admissions for nonambulatory care sensitive conditions with no increases in care intensity. Obtaining Medicaid insurance increased the relative proportion of ED visits requiring hospital admission suggesting increased outpatient access for low-acuity conditions previously addressed with ED care.
我们考察了 2014 年《患者保护与平价医疗法案》（Patient Protection and Affordable Care Act）实施后，获得医疗补助保险的无保险患者在急诊部（ED）就诊的严重程度和护理强度的变化。我们使用了来自 7 个州的 30 个急诊室的 2013-2015 年纵向患者就诊水平数据，这些数据来自一个急诊医学组。我们使用倾向评分加权方法和统计机器学习来估计权重，对以前没有医疗保险的医疗补助患者和在扩张前和扩张后仍未保险的重复使用 ED 的患者（≥1 次就诊）的 ED 使用情况进行了检查。与非扩张州中仍未保险的患者相比，扩张州中新获得医疗补助保险的患者的住院率相对增加了 29%，非流动性护理敏感状况的住院率增加了 32%，而护理强度没有增加。获得医疗补助保险增加了需要住院治疗的 ED 就诊的相对比例，这表明以前通过 ED 护理解决的低严重程度的门诊就诊机会增加。
