National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA; Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.
Duke Margolis Center for Health Policy, Washington, DC, USA; National Pharmaceutical Council, Washington, DC, USA.
J Am Med Dir Assoc. 2022 May;23(5):852-857.e5. doi: 10.1016/j.jamda.2021.08.020. Epub 2021 Sep 21.
This study examines the effect of Medicaid eligibility expansion under the Affordable Care Act (ACA) on the utilization of nursing home services by younger individuals and those covered by Medicaid.
Compared the age of nursing home residents, proportion of individuals covered by Medicaid, annual nursing home admissions in those younger than 65, and nursing home length of stay in states that expanded Medicaid eligibility through the ACA to states that did not. We used data from LTCFocus (nursing home level), the Minimum Data Set (individual level), and Medicaid expansion status from the Kaiser Family Foundation.
The study included 15,005,888 nursing home admissions, 2,446,950 of which were residents younger than 65, across 14,132 nursing homes between 2009 and 2016.
A time-varying difference-in-difference model including state and year fixed effects with effect modification by pre-2014 nursing home occupancy.
Facilities in expansion states with a pre-ACA occupancy rate of more than 70% increased the fraction of residents younger than 65 by 2.74% to 6.32%, compared with similar facilities in nonexpansion states. Medicaid admissions varied, with an increase in year 2 after expansion compared with nonexpansion states. Among residents entering from an acute care hospital, the proportion younger than 65 increased in facilities with pre-2014 occupancy rates of more than 70%, compared with similar facilities in nonexpansion states, an increase of up to 6.51%. Median nursing home length of stay for individuals younger than 65 decreased relative to nonexpansion states across all occupancy categories, ranging from 1.68 to 6.06 days after Medicaid expansion.
Medicaid expansion increased access to nursing home post-acute care for individuals younger than 65. It remains unclear if the benefit of post-acute care is the same among this group, or if the needs of younger individuals can be adequately met in this setting.
本研究考察了《平价医疗法案》（ACA）下医疗补助资格扩大对年轻人群体和医疗补助覆盖人群使用疗养院服务的影响。
比较了疗养院居民的年龄、医疗补助覆盖人群的比例、65 岁以下人群的年度疗养院入院人数以及医疗补助资格扩大的州与未扩大的州的疗养院入住时间。我们使用了来自 LTCFocus（疗养院层面）、最低数据集（个人层面）和 Kaiser Family Foundation 的医疗补助扩张状况的数据。
这项研究包括了 2009 年至 2016 年期间 14132 家疗养院的 15005888 例疗养院入院病例，其中 2446950 例为 65 岁以下的居民。
采用时间变化的差分法模型，包括州和年份固定效应，并通过 2014 年前疗养院入住率进行效应修饰。
在 2014 年前入住率超过 70%的扩张州的疗养院，与非扩张州的类似疗养院相比，65 岁以下居民的比例增加了 2.74%至 6.32%。医疗补助入院人数有所不同，与非扩张州相比，扩张后的第二年增加。对于从急性护理医院入院的居民，在 2014 年前入住率超过 70%的疗养院中，65 岁以下居民的比例与非扩张州的类似疗养院相比有所增加，增幅高达 6.51%。在所有入住率类别中，65 岁以下人群的疗养院中位住院时间都相对减少，在医疗补助扩张后减少了 1.68 至 6.06 天。
医疗补助的扩大增加了 65 岁以下人群接受疗养院急性后护理的机会。目前尚不清楚这种急性后护理对这一群体是否同样有益，或者年轻人群体的需求是否能在这种环境下得到充分满足。
