Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA.
Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA.
Med Care. 2021 Jul 1;59(7):653-660. doi: 10.1097/MLR.0000000000001523.
Some states expanded Medicaid under the Affordable Care Act, boosting their low-income residents' demand for health care, while other states opted not to expand.
The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices.
Using 2009-2019 data from the American Medical Association Physician Masterfile and information on states' Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following implementation of the expansion to where they located during the 5 years preceding implementation.
The sample consisted of 160,842 physicians in 8 specialty groups.
Thirty-three states and the District of Columbia expanded Medicaid by the end of the study period. Compared with preexpansion patterns, we found that physicians in one specialty group-general internal medicine-were increasingly likely to locate in expansion states with time after the expansion. The Medicaid expansion influenced the practice location choices of men and international medical graduates in general internal medicine; women and United States medical graduates did not alter their preexpansion location patterns. Simulations estimated that, between 2014 and 2019, nonexpansion states lost 310 general internists (95% confidence interval, 156-464) to expansion states.
The Medicaid expansion influenced the practice location choices of new general internists. States that opted not to expand Medicaid under the Affordable Care Act lost general internists to expansion states, potentially affecting access to care for all their residents irrespective of insurance coverage.
一些州根据《平价医疗法案》扩大了医疗补助计划，增加了低收入居民对医疗保健的需求，而其他州则选择不扩大。
本研究旨在确定医疗补助计划的扩大是否影响了刚刚完成住院医师规范化培训的医生选择开设其第一家诊所的州。
利用美国医学协会医师主文件的 2009-2019 年数据和各州医疗补助计划扩大状况的信息，我们采用条件逻辑回归模型来比较在扩大实施后的 6 年内新医生的执业地点与扩大实施前 5 年内的执业地点。
该样本包括 8 个专业组的 160842 名医生。
截至研究期末，有 33 个州和哥伦比亚特区扩大了医疗补助计划。与扩大前的模式相比，我们发现一个专业组-普通内科医生-的医生随着时间的推移越来越有可能在扩大后的州执业。医疗补助计划的扩大影响了普通内科医生中男性和国际医学毕业生的执业地点选择；女性和美国医学毕业生并没有改变他们扩大前的执业地点模式。模拟估计，在 2014 年至 2019 年期间，非扩大州向扩大州流失了 310 名普通内科医生（95%置信区间，156-464）。
医疗补助计划的扩大影响了新的普通内科医生的执业地点选择。在《平价医疗法案》下选择不扩大医疗补助计划的州向扩大州流失了普通内科医生，这可能会影响所有居民的医疗服务可及性，而不论其保险覆盖情况如何。
