John Chambers College of Business and Economics, West Virginia University, Morgantown, West Virginia.
College of Business Administration, University of Wisconsin-La Crosse, La Crosse, Wisconsin.
J Stud Alcohol Drugs. 2020 Nov;81(6):750-759.
The purpose of this study was to measure changes in the payer mix and incidence of emergency department (ED) opioid-related overdose encounters after an April 2014 expansion of Medicaid to childless adults led to a 43% increase in Medicaid coverage for men and 8% for women statewide.
We explored two competing hypotheses using data visualization and comparative interrupted time-series analysis (CITS): (a) expanded eligibility for Medicaid is associated with a change in payer mix only and (b) sociodemographic groups that gained Medicaid eligibility were more likely to use ED services for opioid overdose. Data included encounters at all Wisconsin nonfederal hospitals over 23 quarters from 2010 to 2015 and American Community Survey estimates of pre- and post-policy Medicaid eligibility by sex and age.
We found an increase in the share of opioid-related ED visits covered by Medicaid for men and women ages 19-29 and for men ages 30-49 following the expansion. The number of visits increased substantially in April 2014 for men ages 30-49, with Medicaid-covered visits driving this result. We found little evidence of an increase in overall visits for other age groups for either men or women.
The relationship between Medicaid expansion and opioid ED use is complex. Changes in case mix and increased access to care likely both play a role in the overall increase in these ED visits. Being uninsured may be an important barrier to seeking emergency care for opioid-related overdoses.
本研究旨在衡量 2014 年 4 月扩大医疗补助计划（Medicaid）覆盖范围，使全州范围内男性 Medicaid 覆盖率增加 43%，女性增加 8%后，患者支付方组合和急诊部（ED）阿片类药物相关过量就诊的发生率的变化。
我们使用数据可视化和对比中断时间序列分析（CITS）探索了两种相互竞争的假设：（a）扩大 Medicaid 资格与支付方组合的变化有关，以及（b）获得 Medicaid 资格的社会人口统计学群体更有可能因阿片类药物过量而使用 ED 服务。数据包括 2010 年至 2015 年 23 个季度的所有威斯康星州非联邦医院的就诊记录，以及美国社区调查（American Community Survey）对政策前后 Medicaid 资格的按性别和年龄划分的估计。
我们发现，在扩张后，19-29 岁和 30-49 岁男性以及 30-49 岁男性的阿片类药物相关 ED 就诊中，由 Medicaid 覆盖的比例增加。2014 年 4 月，30-49 岁男性的就诊次数大幅增加， Medicaid 覆盖的就诊次数推动了这一结果。我们几乎没有发现其他年龄组男性或女性的总就诊次数增加的证据。
Medicaid 扩张与阿片类药物 ED 使用之间的关系是复杂的。病例组合的变化和获得更多医疗保健的机会可能都在这些 ED 就诊的总体增加中发挥了作用。没有保险可能是寻求阿片类药物相关过量急诊治疗的一个重要障碍。
