平价医疗法案对结肠手术的可及性和结果的影响。
The effects of the Affordable Care Act on access and outcomes of colon surgery.
机构信息
University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
University of Pennsylvania, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA.
出版信息
Am J Surg. 2021 Sep;222(3):613-618. doi: 10.1016/j.amjsurg.2021.01.019. Epub 2021 Jan 19.
BACKGROUND
Insurance status has been strongly associated with both access to and outcomes of colon resection (CRS). Under the Affordable Care Act (ACA), individual states opted to participate in Medicaid expansion (ME) and adopt essential health benefits (EHB).
METHODS
We performed a quasi-experimental difference-in-differences (DID) analysis of 2012-2017 state-level inpatient claims with risk adjustment. We examined frequency of emergent presentation and in-hospital death. Subset analyses were performed by insurance type.
RESULTS
Among the 73,961 CRS patients, 49.6% were in a state with both ME and EHB, 34.7% presented emergently, and 2.0% died. Adoption of ME and EHB was associated with a significant, 24%, reduction in the likelihood of in-hospital mortality, and no significant change in emergent presentation for CRS.
CONCLUSIONS
The ACA's ME was strongly associated with a decrease in mortality following colon resection among Medicaid beneficiaries. These findings support the adoption of healthcare policies that improve access to insurance.
背景
保险状况与结肠切除术（CRS）的获得和结果密切相关。根据《平价医疗法案》（ACA），各州选择参与医疗补助扩展（ME）并采用基本健康福利（EHB）。
方法
我们对 2012-2017 年进行了风险调整的州级住院患者索赔进行了准实验性差异（DID）分析。我们检查了紧急就诊和院内死亡的频率。按保险类型进行了亚组分析。
结果
在 73961 例 CRS 患者中，49.6%的患者所在的州同时实施了 ME 和 EHB，34.7%的患者紧急就诊，2.0%的患者死亡。采用 ME 和 EHB 与院内死亡率显著降低 24%相关，而 CRS 紧急就诊没有明显变化。
结论
ACA 的 ME 与医疗补助受益人的结肠切除术后死亡率降低密切相关。这些发现支持了通过改善保险获取来实施医疗保健政策。
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