平价医疗法案医疗补助扩张对社区卫生中心口腔手术服务提供的影响：一项观察性研究。
Impact of the Affordable Care Act Medicaid expansion on oral surgery delivery at community health centers: an observational study.
机构信息
Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, 84108, USA.
Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH, 43210, USA.
出版信息
BMC Oral Health. 2021 Oct 20;21(1):540. doi: 10.1186/s12903-021-01895-4.
BACKGROUND
Unmet oral health needs routinely affect low-income communities. Lower-income adults suffer a disproportionate share of dental disease and often cannot access necessary oral surgery services. The Affordable Care Act (ACA) Medicaid expansion created new financial opportunities for community health centers (CHCs) to provide mission-relevant services in low-income areas. However, little is understood in the literature about how the ACA Medicaid expansion impacted oral surgery delivery at CHCs. Using a large sample of CHCs, we examined whether the ACA Medicaid expansion increased the likelihood of oral surgery delivery at expansion-state CHCs compared to non-expansion-state CHCs.
METHODS
Exploiting a natural experiment, we estimated Poisson regression models examining the effects of the Medicaid expansion on the likelihood of oral surgery delivery at expansion-state CHCs relative to non-expansion-state CHCs. We merged data from multiple sources spanning 2012-2017. The analytic sample included 2054 CHC-year observations.
RESULTS
Compared to the year prior to expansion, expansion-state CHCs were 13.5% less likely than non-expansion-state CHCs to provide additional oral surgery services in 2016 (IRR = 0.865; P = 0.06) and 14.7% less likely in 2017 (IRR = 0.853; P = 0.02). All else equal, and relative to non-expansion-state CHCs, expansion-state CHCs included in the analytic sample were 8.7% less likely to provide oral surgery services in all post-expansion years pooled together (IRR = 0.913; P = 0.01).
CONCLUSIONS
Medicaid expansions can provide CHCs with opportunities to expand their patient revenue and services. However, whether because of known dental treatment capacity limitations, new competition, or coordination with other providers, expansion-state CHCs in our study sample were less likely to provide oral surgery services on the margin relative to non-expansion-state CHCs following Medicaid expansion.
背景
未满足的口腔健康需求经常影响低收入社区。低收入成年人患牙科疾病的比例过高，往往无法获得必要的口腔外科服务。《平价医疗法案》（ACA）扩大了医疗补助计划，为社区卫生中心（CHC）在低收入地区提供与使命相关的服务创造了新的财务机会。然而，文献中对 ACA 医疗补助计划扩大如何影响 CHC 的口腔外科手术服务知之甚少。本研究使用大量 CHC 数据，考察了 ACA 医疗补助计划扩大是否增加了扩张州 CHC 提供口腔外科手术的可能性，与非扩张州 CHC 相比。
方法
利用自然实验，我们估计泊松回归模型，考察医疗补助计划扩大对扩张州 CHC 提供口腔外科手术的可能性的影响，与非扩张州 CHC 相比。我们合并了 2012-2017 年多个来源的数据。分析样本包括 2054 个 CHC 年观测值。
结果
与扩张前一年相比，扩张州 CHC 提供额外口腔外科服务的可能性在 2016 年比非扩张州 CHC 低 13.5%（IRR=0.865；P=0.06），在 2017 年低 14.7%（IRR=0.853；P=0.02）。在其他条件相同的情况下，与非扩张州 CHC 相比，分析样本中扩张州 CHC 在所有扩张后年份提供口腔外科服务的可能性平均低 8.7%（IRR=0.913；P=0.01）。
结论
医疗补助计划扩大可以为 CHC 提供扩大患者收入和服务的机会。然而，无论是由于已知的牙科治疗能力限制、新的竞争，还是与其他提供者的协调，在我们的研究样本中，扩张州 CHC 在医疗补助计划扩大后，在边缘地区提供口腔外科服务的可能性低于非扩张州 CHC。
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