Central Michigan University, Health Professions Bldg. 2238, Mt Pleasant, MI 48858, USA. Tel 815-520-2982.
J Allied Health. 2020 Winter;49(4):274-278.
The study aimed to estimate the effect of the Affordable Care Act (ACA) Medicaid expansion on safety-net hospital uncompensated care. Data from a balanced panel of short-term, general, nonfederal, Medicare-certified hospitals were obtained from Medicare cost reports from 2011 to 2014.
Difference-in-differences and logistic analyses were performed using hospitals in non-expansion states as the control group. The dependent variable was hospital provision of uncompensated care. The data came from the National Bureau of Economic Research website.
Medicaid-expanded and non-Medicaid-expanded population.
Medicaid expansion.
Improve fiscal measures on Disproportionate Share Hospitals (DSH) and understand the effects of Medicaid expansion on hospital operations.
Medicaid expansion significantly reduced hospital provision of uncompensated care in 2014. In particular, within expansion states, DSH hospitals saw reductions beyond those experienced by non-DSH hospitals.
This study indicates that the Medicaid expansion increased access to Medicaid insurance. Expanded states showed a decrease in uncompensated care in comparison to non-expanded states. However, although a decrease in uncompensated care is apparent, hospitals in expanded states did not decrease their costs, which raises further questions about whether Medicaid expansion had a direct effect on hospital service costs.
本研究旨在评估平价医疗法案（ACA）医疗补助扩展对医疗服务提供体系医院（safety-net hospital）无偿医疗服务的影响。数据来自 2011 年至 2014 年医疗保险成本报告中的 Medicare 成本报告，来自平衡的短期、一般、非联邦、医疗保险认证医院的综合面板。
采用非扩张州的医院作为对照组，使用差异分析法和逻辑分析法。因变量为医院提供的无偿医疗服务。数据来自国家经济研究局网站。
医疗补助扩大和非医疗补助扩大的人群。
医疗补助扩大。
改善《不成比例分担医院法》（Disproportionate Share Hospitals，DSH）的财政措施，并了解医疗补助扩大对医院运营的影响。
医疗补助扩大显著降低了 2014 年医院提供的无偿医疗服务。特别是在扩张州，DSH 医院的降幅超过了非 DSH 医院。
本研究表明，医疗补助扩大增加了医疗补助保险的获得机会。与非扩张州相比，扩张州的无偿医疗服务有所减少。然而，尽管无偿医疗服务明显减少，但扩张州的医院并未降低成本，这进一步引发了关于医疗补助扩大是否对医院服务成本产生直接影响的问题。
