Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
US Acute Care Solutions, Canton, Ohio, USA.
Health Econ. 2020 Dec;29(12):1682-1704. doi: 10.1002/hec.4157. Epub 2020 Sep 16.
Prior research has found that in states which expanded Medicaid under the Affordable Care Act, hospital Medicaid revenue rose sharply, and uncompensated care costs fell sharply, relative to hospitals in nonexpansion states. This suggests that Medicaid expansion may have been a boon for hospital revenue. We conduct a difference-in-differences analysis covering the first four expansion years (2014-2017) and confirm prior results for Medicaid revenue and uncompensated care cost, over this longer period. However, we find that hospitals in expansion states showed no significant relative gains in either total patient revenue or operating margins. Instead, the relative rise in Medicaid revenue was offset by relative declines in commercial insurance revenue. In subsample analyses, we find higher revenue and margins for rural hospitals in expansion states, little change for small urban hospitals, and a revenue decline for large urban hospitals.
先前的研究发现，在《平价医疗法案》下扩大医疗补助计划的州，与未扩大的州相比，医院的医疗补助计划收入大幅上升，而免费医疗成本大幅下降。这表明医疗补助计划的扩大可能对医院的收入是一个福音。我们进行了一项差异分析，涵盖了前四年的扩张期（2014-2017 年），并在更长的时间内确认了之前关于医疗补助计划收入和未补偿护理成本的结果。然而，我们发现，在扩张州的医院在总患者收入或运营利润率方面并没有显著的相对收益。相反，医疗补助计划收入的相对增长被商业保险收入的相对下降所抵消。在子样本分析中，我们发现扩张州的农村医院的收入和利润率更高，小型城市医院几乎没有变化，而大型城市医院的收入则下降。
