Clinical Health Systems and Analytics Division, Duke University School of Nursing, Durham, North Carolina.
Sickle Cell Data Collection Program, Tracking California/Public Health Institute, Richmond, California.
Pediatr Blood Cancer. 2020 May;67(5):e28152. doi: 10.1002/pbc.28152. Epub 2020 Mar 8.
Sickle cell disease (SCD) is associated with high acute healthcare utilization. The purpose of this study was to examine whether Medicaid expansion in California increased Medicaid enrollment, increased hydroxyurea prescriptions filled, and decreased acute healthcare utilization in SCD.
Individuals with SCD (≤65 years and enrolled in Medicaid for ≥6 total calendar months any year between 2011 and 2016) were identified in a multisource database maintained by the California Sickle Cell Data Collection Program. We describe trends and changes in Medicaid enrollment, hydroxyurea prescriptions filled, and emergency department (ED) visits and hospital admissions before (2011-2013) and after (2014-2016) Medicaid expansion in California.
The cohort included 3635 individuals. Enrollment was highest in 2014 and lowest in 2016 with a 2.8% annual decease postexpansion. Although <20% of the cohort had a hydroxyurea prescription filled, the percentage increased by 5.2% annually after 2014. The ED visit rate was highest in 2014 and decreased slightly in 2016, decreasing by 1.1% annually postexpansion. Hospital admission rates were similar during the pre- and postexpansion periods. Young adults and adults had higher ED and hospital admission rates than children and adolescents.
Medicaid expansion does not appear to have improved enrollment or acute healthcare utilization among individuals with SCD in California. Future studies should explore whether individuals with SCD transitioned to other insurance plans or became uninsured postexpansion, the underlying reasons for low hydroxyurea utilization, and the lack of effect on hospital admissions despite a modest effect on ED visits.
镰状细胞病（SCD）与高急性医疗保健利用率相关。本研究的目的是检查加利福尼亚州的医疗补助扩张是否增加了医疗补助的参保人数，增加了羟基脲处方的数量，并减少了 SCD 患者的急性医疗保健利用。
从加利福尼亚镰状细胞数据收集计划维护的多源数据库中确定了 2011 年至 2016 年期间，年龄≤65 岁且在医疗补助计划中至少有 6 个完整的日历月的 SCD 患者。我们描述了加利福尼亚州医疗补助扩张前后（2011-2013 年和 2014-2016 年）医疗补助参保人数、羟基脲处方数量以及急诊就诊和住院的趋势和变化。
队列中包括 3635 人。参保人数在扩张后最高（2014 年），最低（2016 年），扩张后每年下降 2.8%。尽管只有不到 20%的患者有羟基脲处方，但在扩张后每年增加 5.2%。急诊就诊率在 2014 年最高，在 2016 年略有下降，扩张后每年下降 1.1%。住院率在扩张前后相似。年轻人和成年人的急诊就诊率和住院率高于儿童和青少年。
医疗补助扩张似乎并未改善加利福尼亚州 SCD 患者的参保人数或急性医疗保健利用情况。未来的研究应探讨 SCD 患者在扩张后是否转向其他保险计划或失去保险，羟基脲利用率低的根本原因，以及尽管急诊就诊率略有下降，但对住院率没有影响的原因。
